21560 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ;, ----------- -n- " ��- ------------ a2.1�. - -----APPLICATION FOR SANITATION PERMIT Permit No. !i (Complete in Duplicate) -- ---------- -------------- Date Issued - � ----------------------------------------- ----- This Permit Expires 1 Year From Date Issued 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. 71C rJ : ,5--Z( 3 S'• ,:wSt�-Lx j A EL.c_o7-A- 4' JOB ADDRESS AND'LOCATIQN------ =------------- �'�.------- - - -- Owner's Name--------------------------- - Phone--- `% ,F�-------- Address------------_-Name ��R[`+t.Q�/- x�-- . fc -----------------••---------------------------. Contracto 's � ----------------------- Phone----------------------------------- Motel ❑ Other E]Installation will serve: Residence © Apartment House ❑ Commercial E] Trailer Court ❑ h' Number of living units: ------- Number of bedrooms a---.- Number of baths _/----- Lot size ---------------------------------------------------•-----� u Water Supply: Public systeml:❑ Community system [I Private a Depth to Water Table 9/---- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel F1 Sandy Loam E] Clay Loam El Clay ga' Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ i, TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewpr is available w' feet.) Septic Tank: Distance from nearest we `�'i�r rom foundation--- _______________MateriaV_.---.--_---_---_..___...___-------------------. No. of compartments-------- --l------------Size ------- ---------Liquid de pth--.------------------------Capacity-_------------------- r Dis osa Field: Distance from nearest well-----� _---Distance from foundation..__--r-_--------.Distance to nearest lot line------ --------- Number of lines---------------1-_._...-..__ ___Length of each line---------___ 6_�__..----Width of trench.-_.___. .----_--_--.-- Type of filter material-------�~G�S`�-Depth of filter material_------ -�+-----Total ►ength_____________ a_�______._-_______._ SI a Seepage Pit: Distance to nearest well --____--Distance from foundation-----oAr--------Distance to nearest lot lme__.Q ._--__.___ ❑ Number of pits.------.X--------Lining material_.- --- ----------------------- d stanc material------------------------------------- . El Size: Diameter--------------------------------------Depth----------------------------- ----------------------Liquid Capacity--- gals. { Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-------------------------------------------- r ❑ Distance to nearest lot line----------------- ------- ------------------- ------------------------------- { 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 rules and regulations of the San Joaquin Local Health District. = {Owner and/or Contractor) a I (Signed)--------------f� �`-------_---------------- --- 'I Title (Plot plan, showing size of lot', location of system in relation to wells, buildings, etc., can be placed on reverse side). l FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- DATE --------- ----------------------------------------------------------------------- REVIEWED BY----------------------- DATE -------------- BUILDING PERMIT ISSUED-ii - - ---- -------- - ---------------- DATE---------------------------------------------------------- -- - ----------J_�Z Alterations and/or recommendatio ._ ------ ------- -----------•----------------•-------------------------•------------- 'i - ------------------•-----------------..---- ---•---------------• ------------------------------------------------------ ...__.----'-...... --------------- ------ ___________ _________________________________________ i' / i FINAL INSPECTION BY:.`;� ra_ -_ Date /�� - -------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha=elton Ave. ;; 300 West Oak Street 124 Sycamore Street 205 West 9th Street q! Stockton,California Lodi,California Mantecar California Tracy,California F..RCC.