21438 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ----- ---------------- ------------- -- -------------- APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) __7 ------------- -- --------------- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and i all the work herein described. This application is made in compliance with County Ordinance No. 549. /+7� 7-0 '(D—D-5, LOCAT�N � r •- -�- JOB ADDRESS AND ------ ------ Phone F_____________ __________---------------------Owner's Name---------- L-rn- Address-------- f --------- --- /1,f�7 _ -----------------------------------------------•-----------------•-•------•------ Contractor's Name------- � - -f1---r----- Phone.. Installation will serve: Residence ®!'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/--- Number of bedrooms J-. Number of baths A-7--- Lot size _4?�e5g- ----------------•--------- Water Supply: Public system ElCommunity system ElPrivate ®!depth to Water Table ;P'gP"ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay &- Adobe 0- Hardpan ❑ Previous Application Made: (If yes,date--------- -- --- -.) No Rt' New Construction: Yes ['] No [�]— FHA/VA: Yes ❑ No K4-- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is`available within 200 feet.) - Seoic Tank:, Distance from nearest well_________________Distance from foundation--------------------Material--------------------------.___-______-_.-._____-- ��'��/ No. of compartments------- -----------------Size---------------------------------Liquid depth--------------------------Capacity...-------------------- � Disposal Field; Distance from nearest welL_�0------Distance from foundation__�40._-__---.Distance to nearest lot line ___ /V//.l F� Number of lines___.__f ength of each line___6/0 - _- Width of trench_________________________._ IQ r --. Type or filter material� i��rryy -Depth of filter material._!- -- ----Total length-_- ---------------------------- }� Seepage Pit: Distance to nearest well_ d x/______Distance fr m foundation___zQ--------Distance to nearest c�lot line_,f�V_-. Number of pits___-_----------Lining material_ �J- -Size: Diameter_s7.3_------.____Deptholt �---- --------- Cesspool: Distance from nearest well---------------.--Distance from foundation--------------------Lining material__-_-.______--__-__.______._______-. ❑ Size: Diameter----------------- ---------------------Depth------ ---------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well___________________________________ Distance from nearest building__-__-.-___________________---___.__.___- v ❑ Distance to nearest lot line.- - ----- -------------- --------------------------------------------------------------------•------ R Remodeling and/or repairing (describe):----------- €!` q��•---------------------•-------------------------------------------------------- -----------------------•-------------------------------------------------------------------------------------------------------------------------------------------- -- -- - ----------...--------- --------------------- h 1 ---------------- ------------------------------------------•------------------------ ---------------------------------------------------------------------------------------------------------------------------------------C -------------------------•-------------------------------------------------------- -------------------------------------------------------_-_- ---- 1 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)-------------------------------�f� f I � /`� � ---- ------------------------------------------------ - -----------------------------------------:---{ -�or Contractor] B ------------------- -- ---- {Title) G�t�/Iwi—" --...__.... -_.. i Y . . (Plot I. showing size of lat, location of system ' elation to wells,-buildings, etc.,.can-be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY-------- --------------- -- ---------- ------------------------------------------------ DATE---------------------- ------------------------------------ REVIEWEDBY------------------------------------------------- ------------------------------r ------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED---------------------------------- ------------------------------------°•------------------------------ DATE.------------------------------=---------------------------- Alterations and/or recommendations------------------------:-----------------------•-----------------------------------------------•------------------••-------• --•--- ------------------------- ---------------------- ------------------- ------------------------------ -------------------------------------------------------------------------------------•------------------------------------- --------------------------'----------------------------------------- ---------------------------- -------------------------------- ' r - --------------- ------------------------------------------------------------------------------------- FINAL INSPECTION BY:----- -_-._ LylDate--------------fJ- (-- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Na=elton Ave. 300 West Oak Street 124 Sycamore Street * 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.C C.