21400 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ------------ ----------------------------------- Permit No. :�.. ----------------------- ----------------- ---- APPLICATION FbR SANITATION PERMIT , (Complete in Duplicate) Date Issued _- ------•-- This Permit Expires 1 Year From Date Issued ---------- ------ ---- ------- v� Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. / This application is made in compliance with County Ordinance No. 549. -n---- $-- wd y----- j JOB ADDRESS AND LOCATION------ n��_ /� __ c"SD_�?ST---��---------�'1-�`-�-------------- ----------- Owner's ------------ --------- -------------- T n !_!m 41 --------- ------- Phone_ 3 Owner's Name-------------------------- -- ---•-------------- ------------ ------ --- -------- ---- -- Address-------------- 1--` °`� ' �----•-X ------------ Contractor's Name--------------------ohmrPhone-- -------- - - ----------------------------------- Installation will serve: Residence Fkr Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J---- Num er o�sys r*s t3_ Number of baths -------- Lot size ____--cmaa-'��-----------------------•----------- Water Supply: Public system ❑ Com uni y � Private 41 Depth to Water Table 1l._ ft. Character of soil to a depth of 3 feet: Sand (Gravel F] Sandy Loam [Clay Loam ❑ Clay C] Adobe❑ Hardpan C] Previous Application Made: (if yes,date........... .......l No [� New Construction: Yes R No ❑ FHA/VA: Yes ❑ No Ej' f� TYPE OF INSTALLATION AND SPECIFICATIONS: r (No septic tank or cesspool permitted if public sewer is available within 2d0 feet.] jCl -Material �pT7Cr2�------ Septic Tank: Distance from nearest weII@T'�'-_Distance from foundation___JO_. No. of compartments-_-- se�. - --------- Size--- /a--- ---Liquid depth---'r?A-'-------------Capacity--��-t Z� - Disposal Field: Distance from nearest welAWPI f---Distance from foundation._�D-- Distance to nearest lot gine_ - - ._.- 21- Number of lines.............. ?_.------------- --Length of each line--------, _-............Width of trench------P�_.....-,•------------------ Type of filter material3e�}, �OOKDepth of filter material---._)Sr...........Total length ----- Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------Distance to nearest lot line---------------- F1 Number -----❑ Number of pits--------------------- - -Lining material--------- -------------Size: Diameter- ------ -------------Depth-- ----------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------- al-- _ Depth--------------------------------------------------•-Liquid Capacity----------------------------gals- - l Size: Qiameter. ---- - Privy: Distance from nearest well--�- ._-----Y---_-______-___ ------.---Distance from nearest building------------------------------------------ 0 ------------------- Remodeling to nearest lot line-------- ----------- -- -------•------------------------------------------------------------ -------- - 1 ' Remodeling and/or repairing (describe):------------------------------------------------------• --------------------`- -------------•--•--- --------------------------------•------------------- ___ --------------------------------------------------------------------------------------------------------------------------------------- --- 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 rule and reguiati . s of the San Joaquin Local Health District. -------------------------------------------------(Owner and/or Contractor) - ---- ------------------- (Title) ----------- ----- (Plot plan, showing size of lot, location of system in relation to wells, buildings, a+c., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY. A------------ ---- DATE -' --------------------- ------------ ------------------------------- REVII=WED BY--------------------------------------------------- --------------------------------------------- ---------------------------� • DATE------ ---------------------------------------------------- BUILDING PERMIT ISSUED-------------------------- ------ DATE------ ------------------- --------------------------------- Alterations and/or recommendations:._.--------------------- ----- ---- -----•-------- ------------------•---------- -- ---------------------- ------ -------------------- I FINAL INSPECTION B ..._ f Date-----------1-...�-_.._.-7..rG..� -------------------------------- S N'IOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Av*. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.c o.