20085 - Laserfiche WebLink

Home Browse Search

FUROFFICE USE: Das�,l�Z-�23 - -------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. --------- ------------------------------- - (Complete in Duplicate) _a 8'�G ------------- ----- This Permit Expires 1 Year From Date IssuedAo� Date Issued _/_________-_-.__..-- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descri:led. T is application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCAT ON--4�`-'-----`_u'*�- Gl�e "` h �� ' ________________ _________ ___1_ _____._-_-_ ----_--------_--_-------__-----__-___-.-._- Owner's Name - --------- ----- ------------- ----------------------------- ------------- Phone------------------------------------ Address ----- © ! ---------------------- Contractor's Name 'L1„�"r --------------------------------------------------------------------------------------- Phone..--------------------------------- Installation will serve: Residence qa Apartment House ❑ Commercial ❑ Trailer Court ❑/ Motel ❑ Other ❑ Number of living units: I_____ Number of bedrooms ---X_ Number of baths I---- Lot size -------------- ------------------------ Wafer Supply: Public system ❑ Community system ❑ Private kt Depth to Water Table ;?S- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam q5 Clay ❑ Adobe❑ Hardpan., Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: -- - -(No septic tank or cesspool-permitted-if!public sewer-is.available within-200 feet.)} Septic Tank: Distance from nearest well-----------------Distance from foundation------------._.---- Material__-_-..-_-_-...---------------_-_____._-.-.------ [❑ No. of compartments------ ---------- --------Size--------------------------------Liquid depth--- -----..Capacity--------------_------ Disposal Field: Distance from nearest welJI-6--4....Distance from founda fio .__�. -_____.Distance to nearest lot line--j- Number ine_-� �J Number of lines----- __.____ Length of each line--- _X.---_ Width of trench.__�V,~-____-_.___._--- Type of filter material% .__Depth of filter material----�_ __._______Total length_' -------------------�-rr------------ Seepage Pit: Distance to neares well--OV f_-_Distance from unclation__�O _" __. istance to nearest lotI.e_t�--_-__-_-.__ INumber of pits___ _______________Lining material p____.Size: Diameter.__,?_______.____Depth___ •.-----.._____-_._...___.__ , Cesspool: Distance from nearest well----------------- from foundation---------.----------Lining material__-__..._-_-._-.-..-.-..-_-.----.--. ❑ Size: Diameter--------------------------------- ----Depth----------------------- ---- -- ------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest we]-------------------------------------------------Distance from nearesf building___.__.____-__-.__--------_.---..------. ❑ Distance to nearest lot line----- ------------------------- -------------------------------•--------------------------------------------------------------------------- Remodelingand/or repairing (describe):----- ---------------------------------------------------------------------------------------------------- -------------------------------------------- ------------1------------I----------------------------------------------------------------------------------------------------------------------- ------------------•------------------------------------••----•--------•----------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------ -----------------------------------------------------------------------------------------------------------•-------------------------------------------------------------------------------------------------------- ------- ---------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that 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)!-- lYl� -�------ -�- r - ----------------- ----------- -------------- ----------- ---------------------(Owner and/or Contractor) By:----------------- -----......t--- --• --------------------- -- ---- ------------ -------- ------ '1T _._.... :......- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- -- ---- - --- ---------------------------------------------------------------------- DATE-----�--�-� -- ----- ---------------------------- REVIEWEDBY--------------------------------------------- -------------------------------------------------------------------------------- DATE-------------------------------------------------.. BUILDING PERMIT ISSUED---------------------------------------------------------------------------------------- ------------- DATE------------------------------------------------------------- Alterations and/or recommendations-------- - ----------------- --------------------------------------------------------------------•----•---------------•--------_---------------------------- ----------------------------------------------------------------------- -•---------- -------------------------------------------------------- ------------------.---------------------------------------------:------------- FINAL INSPECTION BY:.-- - . 411--ulloo--------------- Date f Z�_��------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California' Tracy,California