21238 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: �- APPLICATION FOR SANITATION PERMIT Permit No. .c ..._ ---------------- ------------------- - ----------' (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, .575-a7ot-0i JOB ADDRESS AND LOCAT.ON-��--V/_r.4 - ---Q/7___1�lltfyt 11_�I -- ---4?- Owner's�Name------,5-iO ✓. � �e Pltone ---•----••---- Address---- Contractor's Name- --------• L° �LJ- ,Cp -------------------- -•------ ------ Phone---------------------------------• .x,. Installation will serve: Residence .U4-'oApa�tment House ❑ Commercial ❑ Trailer Court E] Motel [3Other ❑ Number of living units: --/-- Number of bedrooms A_-_ Number of baths 4____ Lot size --&-4o 47cf ---- --------------------- Water Supply: Public'system ElCommunity system [IPrivate Depth to Water Table t`t. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Ciay Loam [Clay [] Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date----------- ) No PR-' New Construction: Yes WRO 'No ❑ FHA/VA: Yes g�j— No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: �. (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well--±t"- Distance f om foundation____/___.__..... -------------- ' No. of compartments__-.._____ ---- depth_ -- ------------ Capacity-elva-------- f Disposal Field: Distance from nearest well__ e-.____Distance from foundati __ ------Distance to nearest lot line_e4p-._.... Number of lines ____-___-_.Length of each line-----�10-`--------_-_--..Width of trench..4.--____,__-.-_ I t: ---------- (� Type of filter materialf�./.00jef.!._Depth of filter material--AP____..._ _Total length---��-------------------------------- � f f Seepage Pit: Distance to nearest well_-./x/19____--Distance fr m f undation__�+f�Q__._..Dista�ce to nearest lot iine_l ___..._ ! [ Number of pits_____e_____________Lining material-_ ...Size: Dia.meter_s __.___...___Depth_c?e'f-.__ _ AJ< Cesspool: Distance from nearest well-----------------Distance from foundation------------------..Lining material-_____ _____--_-________-----__.--. a ❑ Size: Diameter----------------- - - -----------=----Depth-------------------------------------- ---- --------Liquid Capacity---------------------------gals. Privy: Distance from nearest well—-----------------------------------------------Distance from nearest building-_-_.__--.._.--------_---___-----___.-_--- 1 ❑ Distance to nearest lot line.---------------- �j ------ ---1 .�_�'�'-•--------------------- Remodeling and/or repairing (describe)-------------------------- --------------------------------------------------------- _____________________________________________________________________________s-_. .. --------__________________---------------------------------------------------------------------------------_-------------------------------------------------------------------------------_______...---___-------------------- 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. _ - - - --------- -------10 11 a�4r Contractor) (Signed) By:------------------------------------------------------------------ - -- -- g - ---------{Title- r�/�� r------------ ----.- - -------------- (Plot -- ---------- (Plot plan, showing size of lot, location of syst n relation to wells,ibuildin s, etc., can be laced on reverse side). t FOR DEPARTMENT USE ONLY R APPLICATION ACCEPTED BY---------� -- ------------------ --- = ------------------ DATE- /! .3 ---------- ----------------- REVIEWEDBY-----------------------------------------------------------------------i------------------------- -------------------------- DATE---- ---------------------------------------------- ------ BUILDINGPERMIT ISSUED------------------------------------------- ------ DATE------------------------------------------------------------ Alterations and/or recommendations:--------------- - -------;---- {---- ------f---------------------------------------•------------ -------------------------------------------------- - i ----------_---------------------------------------------------------------------- ------------------------------------._..______...___.__.___..._._._._._.__..__...__..____________.__.___._.--------------------------------------------------------- ______ � _.__._..._________._--_.._--._._-___-__-__.__--._.___.-_-__._-..____---___--.-.---_.._.__-----___-__.-------...._ --------------------------------------------------------------- ---------------------------- --------------------- ------------ -- ___-----------------_________________________________________ _ ______ ___ ______________------------------------------------------. ..-___..___....____.___________._._..____.._-___._ C� ------ ---------------------- / ------- Date---- ------------------- ------ — FINAL INSPECTION BY_________ ____�..__. = _ -r.f(�.- -��--� - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California. Manteca,California Tracy,California +„ f F.P.CI].