19963 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: . . r , ------------------ APPLICATION, FOR SANITATION PERMIT Permit No. _f 1��-��..,.3__._ I) (Complete in Duplicate) ! 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 install the work herein described. !`his application is mad/nco, fiance with County Ordinance No. 549. JOB ADDRESS AND N__-FI__s_K-----RD-"---, v"- ill/--a " "". 1[ sOT- 11-t------..-.Owner's Name------------- �F C6 �� 8 �l --------------------------------------- ------------------------ -------------- Phone 1 Address :. TE d x-------- 2 JA----------M TK09_- ------------------------------------------------------------------------------- l Contractors Name--------- aw-ma-R-----"•----------•------------------------ - v-- ---- Phone-,--- ------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer .Eertrr{ �atel ❑ Other ❑ Number of living units: _! — Number of bedrooms _ ____ Number of baths __. ___ Lot size ------ Water Supply: Public system [I _Community system ❑ .'Private Depth to Water Table ft. Character of soil to"a depth of feet: Sand Gra el Sand Loam Clay Loam Clay Adobe Hardpan-� ❑ Y ❑ Y ❑ Y ❑ ❑ P ❑ Previous Application Made: (If yes,date___________________ No New Construction: Yes 2-"No ❑ FMA/VA: Yes ❑ No T�YPEFOF-INSTALLATION-AND-SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available wifhin 200 feet.) f Y Septic nk: Distance€�frorn,nearest-welL'�1�----Distance from foundation_/O-_____-___.Material_RETL)�00J>_____________ No. of compartments--------�--_----__Size_ a'1.Q_a _-J� Liquid depth__J��""___--Capacity_./ _O_?T ___ / ., Disposal Field: Distance from nearest well__„�0_____Distance from foundati n__�_Q..____ ...Distance to nearest lot i�e.---------------- Length _"�____- * t r . [' Number 'of. lines----------- _______ ___________ Length of each line-7_ ":� d_ Width of trench.____. ____.___ Typei of{filter material--- �C_V�____Depth of filter material_-__../ ....-____.Total length_----._____./,�Q-__--_--._ �'w1 1 I Seepage Pit: Distance to nearest well------------- --------Distance from foundation______________------Distance to nearest lot line-----.__._..----_ ❑ Number of pits.--------------------Lining material------__ ._._._...-__-Size: Diameter------------.------ _ - . __Depth----- -------------------- ,. Cess ool: ►r Distance. from nearest well-----------______Distance from foundation------------------..Lining material... ........------------------------- El e Diameter ,T - Depth - ----------------Liquid Capacity----------------------------gals. /r , Privy:N Distance from nearest welf-------------------------------------------------Distance from nearest building.---------------------------------------_❑ Distance to nearest lot line.----- - --------- ------------------------------ Remodeling s , RemodLing and/or r ipairing'(describ;) ---------------------------------------------------•------------ -------------------------•---------- -----•------------ - ____________________________________________________________________________________________ ____________________________________________________________ __________________________________________---.___.- �l --------------------------- 1111-----5---------- --- r ----------------------------------------------------- -- --- --------------------------------- -------------------------------------------------------------------------------------------------------------------------- ---------------------------------- ------------------------- 11 1 hereby certify that I hive 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. ,~< (S.igned) J.�7�rr-s�q -------------------------------------------------------- -------Owner and/or Contractor) —.. } , ---� - ---------------------------------- gY g (TitleP. - - - p ------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be laced on reverse side). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED ©------------------------ ------- ---------------------------------------- DATE_.__L -�Z6 -4-S REVIEWEDBY-------------------------------------------------------------------------------------------------------- ------------------ DATE B61LDING PERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE--- ----- ---------------- Alterations and/or recommendations:._ __- "-- - i ---- -.-;--- ----------------------------------- ll -------------------------------- - ------- ------------------------------------------------------------ - - -------------------------------------------------------------------------------------------------------------- ---------- f -------------------------- ------------ -- --- -------- -- ----- -- ... -------------------------------------------------------------- -- ----------------------------- 1 FINAL INSPECT N BY:..-- -- ---- Date-. .-----ry z 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 w . �-� i