22180 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: r --------- -------------------------------------� ----- APPLICATION) FOR�SANITATION ,PERMIT Permit No. �,�-.J.------ ---------- ------------------------- -------------------- v_ r (Complete in Duplicate) ' Date Issued ----------------- _ - ---------------_-_ ------- This Permit Expires,,11 Year Frons Date Issued Application is hereby made to the San Joaquirn,Local Heaffh District for a'permit to construct and install the work herein described. This application is made in compliance with County'Ordinance No. 549. 1 JOB ADDRESS AND LOCATION_=,f -- __ �-_ _ ._ f f- -�e�' --------------------------------------------------- Owner's -- --- ------------------------------------------ Owner's Name ,,,��jj��rr//f�';f /' .� " ----- - Phone Address.-•------/;•:f ---- ;'--- 'f � = .. -.---------- ---.- _..._.-.._.�...--------- --------------•-•- u cf it Contractor's Name_______ ��t' , / Y4 I---------------- Prone------------- installation will serve- Residence ❑ Apartment House ❑ Commercial Trailer Court E] Motel ❑ Other E]. f Number of living units: !r'-__ Number of bedrooms -_ Number cif�;aths - Lot size --_ . <_____________________ r � � � Water Supply: Public system �Colnsystem tem Elf Private ❑ eepth to Water�Tailble _ ft. . Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loan's,Q Clay Loam ❑ Clay ❑ AdobegHardpan E]1 Previous Application Made: (If yes,date__. I No gal New Consfruc#ion: Yes ❑ No [?"`FHA/VA: Yes 71 No gs_ TYPE OF INSTALLATION AND SPECIFICATIONS: i n V (No septic tank or cesspool permitted if public sewer is available within 200 feet.) _... .- .. .. S2ptic Tank: Distance from nearest well-----------------Distance from foundation-------------------.Material-----------------------------------------___----. No. of compartments--------------------------Size -------Liquid depth---------------------------Capacity----------------------- D;sposal Field: Distance from nearest well...--------------Distance from foundation.__.----------------Distance to nearest lot line_____________-_. *� Number of lines-----------------------------------Length of each line- -----------------------------Width of trench-------------------------.------•-- Type of filter material-------------------------Depth of filter material_f�!_-._______-------Total length------------------------------------------ 1 r� Seepage Pit: Distance to nearest well____'�_.______Distance fr foundation_.�s�_______-.pistance to nearest lot ]� Number of pits.._._._._____ Lining maferial': > =Size:`Diameter-6,9...t_..----Depth Cesspool: Distance from nearest well-----------------Distance from foundation___ Lining ma#eriaL_.____.....__.___.____._________.__. k l4 Size: Diameter 1 Depth -�;------- --- ❑ l e „� Liquid Capacity- --------------------------gals. (Privy: Distance from nearest weft______._._____ __ .____�__ 13istance from nearest building_______________________________ ` -'�❑ Distance to nearest lot line- - - - ----- --- -----0------------------------------------------------------------- ------------------ Remodeling and/or repairing (describe}_-_ -.-- --- ------ ; ----n a y i I vN j t..- -----------• ------------------------ , -------------------------- ----------- ------------ -----------------------------------------------------------_-------------4--------------------------------------------------------------------------------- ( 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. '�.:_ } ___ or Contractor (Signed)----------------- ---- - -- --- --- ---- -- --------------------------- -------------- (� a ------------------ ----- -- Title (Plot plan, showing size of lot, location!of s m irs,relation to wells, buildings, etc., can be placed on reverse side). f '""F R EPA ENT USE ONLY APPLICATION ACCEPTED BY----- -.-._ _ �` a DATE---- / ` - - -----------1--------------------------- �f�---- �-- REVIEWED BY----------- --------------------------- ----------------------- - - r --------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED------------- ---------------"=------------------------------------------------------- DATE------------------------------------------------------------ Alterations and/or recommendations:__L-------------------------------------------- I-------- ------------------------------------------------•----------------------------------------- 1 FINAL INSPECTION BY:--------- ------- --- — ----- Date------- 1" ----------------------------------------------- SA JO` UIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street �" 0 124 Sycamore Street . 205 West 9Th Street Stockton,California Lodi,California ' •Manteca,California + Tracy,California