22557 - Laserfiche WebLink

Home Browse Search

`�- - e FOR OFFICE USE: -------------------------------------------------------- = - I APPLICATION FOR—.SANfTATION PERMIT Permit No. A,;;- 7 -- ---------------------------------------- -------- (Complete-in Duplicate) � ` i This Permit Expires 1 Year From Date Issued Date Issued __,_______ __ )_ I Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. I This application is made 1n compliance with County Ordinance No. 549:' - JOB ADDRESS AN OCAT PP t I N------ —S a +� t ` •� AAddress--Name----- Q y--.-_. . ----•- -----------------',-�� -------------- -------------•---- Phone.--.-----------------------�------- ,� r As-_U rY-1 __ Contractor's Name.___._ _._ Phone *� Installation will serve: Residence .Apartment House ❑ Commercial E] Trailer Court ❑ Motel ❑ Other E] Number of living units: /.--- Number of bedrooms a-.. Number of baths._/-_ Lot size ---------------- Water Supply: Public system ❑ Community system ❑ Private Jk Depth to Water Table ft Character of soil to a 'depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------_--- --- . ) No D New Construction: Yes No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: _4(No_septic_tank ar cesspool-permitted.-if.public sewer is-available within-200 feet:) . - T }T"Septic Tank: Distance from nearest well-4----><.--..._Distance from foundation__.___.___-_.Material -----________ ....__....._. ._ -.--_-.Ca acit _._� ?� No. of compartmen#s...___.._�...........Size__�s��.l�.�_Liquid depth...... p y,� . _ Disposal Field: Dista.ncd.from nearest well___._._Distance from foundation_,--1100 ._,0.----.Distance to nearest lot line_--_ Number of lines-----_._. ` ..__ _.. Length of each line__..-�Q_�-.--_- -.-Width of trench._ --�___________________ 7 e�of f..Iter material_ yp ___.__Depth of filter material.-.�_.-._.....-Total length_.____.�'�0___._.._•______... r � 'Seepage Pit: Distancetonearest well__._0.-------Distancefr m fo ndation__Q_ ----- Distance to nearest lot line__.t ._ P Number-'of-pits-�_________-_Lining material-__4 __ Size: Diameter._,,7..r....._Depth-____ Gj Cesspool: Distance from nearest well ----------------Distance from foundation----------------- ..Lining ❑ 1 materia------------------ _.----- ----..-._ ---------- Size: Diameter- ------------- --- - ---------_De th---------------------------------------------------.Liquid Capacity----- -------- - -----------gals. Q f �« Privy: Distance from nearest well----------------------------------- Distance from nearest building� � g------------------------------------------ x ❑ Distance to nearest Iof line ----------------------------- ------------------------------------------------------------------------------------------ --------------- a Remodeling and/or repairing (describe):------------------------------------------ ---------------------------••-•---------------a-- -----------•--------------•---------------------- ------------------------------------------------------------------------------------------------------------------ ------------------------------------------ ---------- ----------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------- � 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. i � s (Signed)---------------------------------------------- -- ---- ---- . -- (Owner and/or Contractor) BY: _ _ / -------- - itle) � -tis awe -.,..... - (Plot plan, showing size lot, cation of s em in relation fo wells,6bu'ildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- - - -------------------------------- ------------- DATE 7 .1� REVIEWED BY------------------------------------ ------ DATE---------------------- ------------------------------------- ---------------------------------------------------------- --- BUILDINGPERMIT ISSUED-------- -- ------ ---------------------------------------------------------------------------------- DATE----------------------- --- -------- --------- -------------- ' Alterations and/or recommendations:------------------------ -.-----. - ------- � ------•--- ------- --- - ----------- ------- ------------------•-------- 40 �� - --------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------- L ,',FINAL ,INSPECTION BY �l � 4a/1.._ Date - .......... ------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT x 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 20.5 West 9th Street Stockton,California Lodi. California Manteca,California Tracy,California E.H.9 2M 1.67 Vanguard Press .� - 1 ��