21176 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: -------------- APPLICATION FOR'SANITATION PERMIT Permit No. f � ----------------- • (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. JOB ADDRESS A LO TION '� .. --------------------•------------------------------ EOwner's Name------- ............- m-----• - -- - ---------------------- Phone------------------------------------ Address----------------- r -------------------------- Contractor's Name 'z`-+ ._...,j)-----..A/-------- ^ � � , Phone.--.77�'!S? Q � Installation will serve: Residence AApartment House Commerci Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---/--- Number of bedrooms-3__ Number of baths __ "Lot size -----7T I—S-0---`—-----.____-_ Water Supply: Public system Community system ❑ 'Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe B---<ardpan ❑� FHA/VA: Yes No Previous Application Made: (If yes,date__)f-�_ -____) No E] New Construction: Yes E] No /VA ❑ ❑ 7 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S& /�- 'Distance from nearest well-----------------Distance from foundation--------------------Material----------..-.-___---_.--._---_--__.--.__----. No. of compartments---- _____ .---Size--------------------------------Liquid depth--------------------------Capacity Disp sal Field: Distance from nearest well 4-W , Distance from foundation.-'-0--------------Distance to nearest lot line---.-_ _... Number of lines_ ------- _____ ____ ____Length of each line____�__� __..Width of trench.,.Z,4L l_.__.._. _ De fh of filter material --1_S �r Total length___.___ . �" ___.__. Type of filter material p Se ge it: Distance to nearest well__ _________-_:_____Distance from foundation------------ to nearest lot line__._____-__--_-_ -Number of pits__.______.-._.---___Lining material---------_________.__:Size: Diameter____-.--__.___._-.._Depth______-_______.____-_-_-.-- Cesspool: Distance from nearest well----------.___._Distance from foundation--------------------Linin g material________.---__.______--.-_--__---.--. ❑ Size: Diameter------------------------------------Depth__J-----------------------------------------------Liquid 'Capacity----------------------------gals. Privy: Distance-from nearest well______________________________'._____--.______Distance from nearest building----._._.------__-___-_____._-____._._. ❑ Distance to nearest lot line--------------------- ------ ----------------------- --------------------------------------------------------- --------- Remodeling and/or repairing (describe):__-__ ----------•--- ------ ------------ - --- - -- -------- - - - ------ �. ---- - � � - --- -- ---------- _ "�_erfifv _ ----- -------- ----.------------------------------------------ --------------- --- ------ ------ ------ --- I he t I have prepared this application and that the work will be done in accordance with San Joaquin County fordinances, State lawjs hpd rules and regulations of the San Joaquin Local Health District. �a �t��r, (Signed) - - T� _ rw --- - --- -- -- ----- . w ntract sIEpT1C TAt`iK--s��a°�rt._ r- - - ri er$a or) 6 915_E._Mi_ner Ave_,-- HO,&36f r-------- --- ------------- - -- ----(Title)-- (Plot plan, showing size of lot, location of system_ in relation to ells, building etc., can be placed on reverse side). f FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- _ _ = f ---------------- -- ------------------ ----------- DATE_____ O -------------------- REVIEWEDBY--------------------------------------------- ---------------------------------- _-.---------------------- ------------------ DATE---------------------------------------------------------- IBUILDING PERMIT ISSUED-----------------------•---------------------------------------_----------------------------------... DATE-=------------------------------- ---------------------- Alterationsand/or recommendations---------------------------------------- --------------------------------------------------------------------------------------------------------------------- 1 ------------------------------------- ------------------------- ------------------------------------------------------------------ ------------------------------------------------------------------------ -------------------------------------------------- ------=-- -------------------------------'-------------------------------- --------------------------------- - --------- --------- -------------------------------------------=---•------------ -------- ------.... -------=- ------------ ------- ( r--� Date--------- -=�-f----r-�� I FINAL INSPECTION BY:.. ` -- - --`-- I ( 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