18854 - Laserfiche WebLink

Home Browse Search

F R OFFICE USE: 6-� ------------- --- Ik APPLICATION FOR SANITATION PERMIT Permit No. ------- - --------------------------------------- -------- -------------II... l ----- -- ----- --------- ------------- --------------- (Complete in Duplicate) Date Issued I_. 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. JOB ADDRESS AND LOCATION.- _� ��--,/�a�- - 4- ------ ----------------------------------------------------- ----------- - �y , Owner's Name-----��------- l��-.�- -------------------------------------------------------- ------- --------------------- Phone------------------------------------ Address-------- - �' ------------ --------------------------------------------------------------------------------------------------------------------------------------------- � Contractor's Name----------•-f�--�-�'--=-=-/4��1�� -------------------------------------------------- ------ Phone---------------------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial elTrailer Court ❑ Mofel ❑ Other ❑ I .t� ;v--� 11 Number of living unit: _""'-- Number of bedrooms �-- Number of baths -_ Lot size _ _ _..._� ----------- ----------------- I�. 6- ft ` Water Supply: Public system_ [Community system ❑ Private ❑ Depth to Water Table I � Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe eHardpan ❑ t Previous Application Made: (if yes,date---------------- --) No RR"O"'New Construction: Yes Zjr"""`No ❑ FHA/VA: Yes ❑ No.?� a i TYPE OF INSTALLATION AND SPECIFICATIONS: Y (No septic tank or cesspool permitted if public sewer is available within 200 feet.)o Septic Tank: Distance` from nearest well-----___-----Distance from foundation------. Mate0 A r' �__� ---------------------- e -- ---------- �' �X .?�-W------_---Liquid depth CapacityIF No. of compartmenfs____ Size_____ ____ __ ------------ -- Disposal Field: Distancef from nearest well....`✓.'------Distance from foundation__,0-7Distance to nearest lot line___t�._______. Number of lines-------/-----�_..____- ---- Length of each line---.94 --- Width of trend ^" I f � Type of,filter material_ Depth of filter material-- ! r___..._Total length----- _.Q-------------------'----- Seepage Pit: Distance to nearest well ______Distance fr m foundation___.`_-----.Distance to nearest lot lid-.�-------- Number of pits-----/_--___._.-Lining material__ .-Size: Diameter - __..----Depth_.IA07__/ 14 11. . Cesspool: Distance from nearest well------_----------Distance from foundation_-_---------------- Lining material------------------------------------- i Size: Diameter Depth ,,..,......Liquid Capacity---------------------------gals. I Privy: Distanclfe from nearest we11-------------------------------------------------Distance from nearest building- --------------------------------------- _I _ } ❑ Distance to nearest lot line-- -------------------- - ----------------I------- ----------------------------------------------- . --------------- II --------- - .�n-'� l Remodeling and/or repairing (describef:------- .L•. --------------------- ------- i -- -- tD _ . sAll tet/ - ! I I he y certify tha l?khave prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sfate laws, and rules and regulations of the San Joaquin Local Health District. Si nad �I 4 °r Contractor) ( - 9 )---------- --- - ----- ifl —-------------- - - -- ---- ---- -J. - ---------- (Plot plan, showing size of Iot, location of system in relation to s, buildings, efc., can be placed on reverse side). FOR DEPARTMENT SE ONLY" f DATE__._._._ _ zz;- ---------------- W APPLICA�BY CCEPTED BY---------- -- I--- --- �" `,- ------------- „ -- -- llI ---------------------- -----------------------------------------':__I DATE f REVIEE - ------------M --------------- BUILDING PERMIT ISSUED------------------ Alterations - - DAJ ------------------------------------------------------------- !! E Alterations and/or recommendations:._..__. ? ! ( ��k` �•�r te."'-•------------------------ ------- ---------------- IIM ------------------------------------------------------- i ----------------- ---------- --------------------------------------------------- Ir -- -------------------- ------------------ ------------- If -------------------- ----------------------------- ------ FINAL INSPECTION BY:- ---- J. .7�----------------- Date.---- / --------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 S,ycomore Street 205 West 9th Street 1i `a� I Stockton,California Lodi,California Mantec;!C'alifornia Tracy,California