20250 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: __ ! __ 'If APPLICATION FOR SANITATION PERMIT Permit No. S-.... --------------------------------------------------------- 11 (Complete in Duplicate) 8- ---------------------------------- ow. ate Issued Date Issued 0� This Permit Expires 1 Year From Date , 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 iri!�compliance with County Ordinance N ,549 . it I / / 3 2-j€'l,Y'!,cr-H l JOB ADDRESS AND - Owner's Name--------------`-n_ 2?. -e-,0�1------------------- ---------------------- ----- ----------------------------------- Phone--------------------•----"-•-------- Address............ 3 __��e_,Elf, ` �/,7/�---_ - p'P----------------------------------------------------. .-.___....»_....---_-__.__---"-__._.-.--.---.-._ Contractor's Name----------f�- -- ---------------------------------------------------------------------•-- ------- Phone----------------------------------- Ifistallation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living unfits: -- Number of bedrooms - _- Number of baths _- _- Lot size --------------------------- 11! -le Water Supply: Public system ElCommunity system 2�re Private ❑ Depth to Water Table a4 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe r Hardpan ❑ Previous Application Made: llf yes,date--------------------- �l ❑ [P— ❑ --� No �" New Construction: Yes o FHA/VA: Yes No 11 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or ��esspooi permitted if public sewer is available within 200 feet.) m SepCtii7c'rTank: DistancI�e� from nearest well___-------Distance from foundation----/--.----.Ma-t-eria_' -- ---------------- No. ofcompartments---- ----------------Size47—' liquid de th----_4e --------__--Ca acit ZZ-al-.--- Disposal Field: Distance from nearest well....-.. .........Distance from foundation____ --_-.Distance to nearest lot line--:07- Number ine_- _7_Number of lines_--------2___________ ________Length of each line---,-P.7��_ ._- ---_.__--.-.Width of trench- ------------------------------ % i� Type olf filter material"___ ,/�O��Depth of filter matEroal--%�'_-___---_-.,Tot"al length---.o-14-47-------------------------- Seepage Pit: Distance to nearest well-___` - Distance from foundation--_- Dystance,tonearest lot line-- 'r----...- Number of pits---,e-.............Lining material_40?.O.e----Size: Diameter-1/X"�,d_"Depth---/f----------------------- Cesspool: -------_-_----.---_Cesspool: Distanlce from nearest well-----------------Distance from foundation......---------..._Lining material---- ❑ Size: Qiameter--------------------- ------- -----Depth_ ----- -- ---------- --- --- --------Liquid Capacity----------------------------gals. /y` Ilf I E --"-Distance from nearest buildin Privy: Distance from nearest well ------ ------------- building------------------------------------------ ❑ Distance to-nearest lot line-------------------------------------------------------------------------------- ---------------------------------------•------- ---------- III! <.. Remodeling and/or repairing (describe):----------- r�-------------�-------------------------------------------------------- ------------------------------------------------------------------------ ------------------------------------------------------------ ------------------------------------ II�I _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, an rules iand r gulations of the San Joaquin Local Health District. (Signed)------------------------------- --�!'--- - - ------- - --------------.{�or Contractor] , : (Title).. rc- (Plot plan, showing size ofllliot, location of system in r ton to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTEID BY- 1 -------------------_------------------------------------------------------ DATE-- ' -------------------------------------- REVIEWED BY ------------III--- DATE - -------------------------------------- BUILDING PERMIT ISSUED-----------------------------------------------------------------------------------------------------. DATE-------------------------- ---------------------------------- Alterations and/or recommendations:"____________ _________ _ !I1I IIS, (IMI ----------------- ------------------------ ------------------ -- -------------------------------- ----------------------- --------------------- -------- ------------------------- FINAL INSPECTION BYII:- � ------------- Date ` SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ma:elton Ave: 300 West Oak Street 124 Sycamore Street 205 West 9th Street I Lodi California` Manteca,California Trac California �. Stockton,Californial y, F.P.Co.