18895 - Laserfiche WebLink

Home Browse Search

--------------- --- ---------- --------- ---------- ------------- APPLICATION FOR SANITATION PERMIT Permit No. ---------- -------------------- -- -------- --------- (Complete in Duplicate) ------------ -------- -- - -- - -- This Permit Expires 1 Year From Date Issued Date Issued _ S� Application is hereby made to the San Joaquin Local Health District for a permit to construct and insialZ�wor �®ri ed. This applica#ion is made in compliance with County Ordinance No. 549. .zfy,i ~ JOB ADDRESS AND LO AT N �,p-- '/ - T Owner's Name--- ��c_--. � - --- -------- I Address----- ... rpt---AW- ----- one Contractor's Name------_ it ------•--•----------••------------------------ F -----------------------••- --------------------------------------------------- ----- --- - -----------. Phone............ f Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ._- Number of bedrooms-- Number of baths #-' Lot size Water Supply: Public system ❑ Communitys s system ❑ Private [ l?epth to Water Table -�. .ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ®'Cla LClay! Yoam ❑ y ❑ Adobe ❑ Hardpan ❑ -C) Previous Application Made: (!f yes,date---- --_.- ) No <7 New Construction: Yeso [�n ❑ FHA/VA: Yes Z;--No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.)1 � _Septic Tank: �D.istance,from nearest=welltr-99--_1D istanerom:f�oundation__-- f�=—TMaterial- �f/� No. of compartmenfs.'p?------------------Siz _.e� ,Z� quid depth---- ----- C a pa city-fZl -.---- Disposal Field: Distance from nearest well_/°�l��pistance from foundation-----,� � -d-�----.Distance to nearest lot lineX�_,f ®� Number of lines.... ----Length of each line_ Q -. _--------.Width of 1 trench. -- Type of filter material-/4AA*Depfh of filter maferial__�* �'----.-Total lengfh_�o,'F".--- o Seepage Pit: Distance to nearest well---------------------Distance from foundation--------------------Distance to nearest lot line Ej Number of Pits- ----------------Lining material-------------- ---------Size: Diameter----------------------Depth--------------------------------- 0�. Cesspool: Distance from nearest well-----------------Distance from foundation-------------------- s -----.Lining material- ------� -- 11 Size: Diameter..- Depth-------------------------- --------------------------Liquid Capacity----------------------------gals. y Privy: Distance from nearest well---- -,------------------------- -----_ ---_Distance from nearest buiidin _ , g Distance to nearest lot line-----------------------_. , + Remodeling and/or repairing (describe:___--_-` f --------------------------- ---- ------------------------------ --------- ------------------------------------------------------1------ -------- ------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------ ------ ---------'----'-------------------------'-------------'------------------------------------------------------------------------------------------------------------------------- --------- ------'---- I hereby certifythat I have prepared this application and that the work will be done in accordance with San Joaquin County � ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) ! - 1 ( o By---------------------------------------------- I r Contractor) Y ----- (Plot-plan ; '-; ,-'showin ..r g-sae of lot,-lots#ion=of.-s s+em in relatio wells,-buildings,:e#c.; canTbe placedlon_reverse_side),_� ( FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_-.._---.-_�. �.- DATEt----- - VIEWED BY--------------=--------- ---------------- --------------- -- --------------------------- DATE-- ' UILDING PERMlT ISS�IED -------------- -------- DATE- i Alterations and/or recommendations--- -------------------- -------------- --------•----------- ------------------------------------ ------------------------------- -- ------------ -------------- - --- ---------____-- --- ---- ---- -- ---- ------------------------------ ---------- ------------------------------ --------------------------------- FINAL ---- ----- ------ FINAL INSP ON $ --- - - - -- Date.---------- / = ..7 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Aw• 300 West Oak'Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California. Tracy,California F.P.C q. k