21772 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ------------------------------------------ --------------- �" APPLICATION FOR SANITATION PERMIT Permit No. ...............----------------------- ------------ -----------------------------=----------------.......... (Complete-in Duplicate) r ' 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 alication is made in compliance with County Ordinance No. 549. �Hp JOB ADDRESS AND LOCATION----------------------7IS_.-- -T tV------r---�-`--------------------------- `�}T •-----�-� ---------------- Owner's Name------l-�--f t 471— r�S CQ 6�ST_��CTl.Q.�l. �� ---------------=------ Phone------------------------------------ Address-----------------------------------L---=a Q-0) ------------,a-�jO2 Contractor's Name----- �--------FU1LLF- Phone ----- ------- ---- ---------------------------------- Installation will serve: Residence eApartment House ❑ Commercial ❑ Trailer Court ❑ . Motel ❑ Other ❑ Number of living units: _1----- N mber of bedrooms 3 Number of baths-2----Lot size __._X44___?C_-L� _--________________________\ -� Water Supply: Public system Community system C1 Private [-] Depth to Water Table 1 2ft Character of soil to a depth of 3 feet- Sand El Gravel E] Sandy Loam [Clay Loam [:] Clay-p. Adobe ❑ Hardpan ❑ ' Previous Application Made: {If yes,date-------------- I Np New Construction: Yes ©�o ❑ FHA/VA: Yes B�No ❑ TYPE OF INSTALLATION AND SPEC IFICAT*NS: (N�o`se�ptic tank or,cesspool per�bed if public sewes�ts.available within 200 fee},) . SeptiTank: Distance m fronearest well.... r.W.Distan'c(� from foundation--------��....Mate" I ___�� Dispoc No. of compartments...._.....�_..-...Size___` -XI . ---Liquiddepth----- ._-__capacity___l_Z�_�_____ sal Field: Distance from nearest well._C:,W_Distance from foundation____f0-::.------Distance to nearest lot line____ _________ f Number of lines _______________2........_Length of each line._ ' d`___57Width of french---------�6_-�_------------- Type of filter material___R.0_C_K.—Depth"of filfer.mate6ai_-.._f_ _..`....Total length------------lFC7___---------------- Seepage Pit: Distance to nearest well--------------- `,Distance from foundation__----__:__--__-__.Distance to nearest lot line_________________ f = ❑ Number of pits--- ----------' `---Lining material----------------- -- Size: Diameter---- ---------------Depth--------.-------------------..-. Cesspool: Distance from nearest well --------- DMance from foundation .. .---- _ Lining material _._________-______________________ Size: Diameter_ __ --------- __De the _.____._____.Liquid Capacity, ------------------------gals. Privy: Distance from nearest well-__._.__._____. _ _•____._Distance-from"nearesf-building____________________________..._._..__._- ❑ Distance to nearest lot {ire ........................ Remodeling and/or repairing (describe):------ -------------- ------••--- --------- -•---------------------------------------------------------- ----------•-------- ------ --------------------------------------------=--------------------------------------------------------------------------------------------------------------------- -- ---------------------------------------------- ----- ------------------------------------------------------------------------------------------------------------------------------------------- ---------------------- -'---------------------------------------- ----------- -- y ----- ---------------------------------------------------------- ---------------------------•--------------------------------------------------------------------------------------------------------------- ------ 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. (Signed)-------------------------------- -------- --------- -............. (Owner and/or Contractor) By� -------------------------------------=_-------------------(Tit.le}.-_:___----------- •-------- = --------- �- - (Plot plan, showin size of lot, location of system in relation to wells,-buildings, etc., can be placed on reverse side). FOR DEP `RTMENT USE ONLY APPLICATION ACCEPTED BY.- _O'- - - ------------ ------------------ ---- -------------- DATE----------•�T-- 747---------------- REVIEWEDBY------------------------------------------------------------------ ---------------------------------------------------- ------ DATE BUILDING PERMIT ISSUED-------- ----- ------------------------------------------------------------------------------- DATE Alterations and/or recommendations: ------ -- ---------- ---------------- -- ------------------------------------------•- ---------------------I---------- ---•----------------------•----•--------------------•--------•----------- -- --------------------. --------------------------------- ------------------------- -------------------------------------------------------------- FINAL INSPE :- ---- - --- - ----- Date --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon 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 i,