21214 - Laserfiche WebLink

Home Browse Search

rVK utrm(_t Ul)E: -- C G APPLICATION FOR SANITATION PERMIT Permit No. �_ `--1 - --- ------ --- ---- (Complete in Duplicate( ----- - This Permit Expires 1 Year From Date Issued Date Issuedl _ _ - - ( 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-- --- Owner's Name. i -Ct' . ............ ....... - Phone--------------- �~ Address-----------` r� �G:- , Contractor's Name--------- 7 ��Y___.. , ��+ - - -- - - ------ - 'ci/? - '1. :° `-- - P ones. . ---- ----- - --- Installation will serve: Residence ' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ------ Number of bedrooms _., Number of baths --r._ Lot size ...... _._1—", - ------------ Water Supply: Public system IX 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 ' Hardpan ❑ Previous Application Made: (If yes,date- ) No X New Construction: Yes ❑ No L2< FHA/VA: Yes ❑ Nom TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: d Distance from nearest well______-------_---Distance from foundation__-.................Material..........____- -..--_.. -------- ......... El /3T1� No. of compartments--- -------- ---------Size-------- ----Liquid depth ----- Capacity isposal Field; Distance from nearest well. ------...Distance Distance from foundation_____________ Distance to nearest lot line_________._____.. ❑ �,YfS��°[ lumber of lines--------.----.---------.---------.Length of each line-----------------------------.Width of trench------------------ Ype oT filter material------„-- - -- _ Depth of filter material..__-----------------Total length-..----...------------------------------- Seepage;Pit: Distance to nearest well__. Distance from foundation_._ f------- - - -�- ��-_- -_-_.Distance to nearest lot line____ Number of pits--- --- -.- Lining material-- �.G', ' - Size: Diameter. - `-- -_--Depth__..... --------- Cesspool: Distance from nearest weU._. ---- Distance from foundation__ ...... ,.Lining material.._._..__-----___-.-_ -------- Privy: Distance from nearest well❑ Size: Diameter- - - - - -- - �- --Depth------- ---- -- - --- -.. - -- -. . Liquid Capacity- --------- --------- - --gals. ___Distance to nearest lot line-- __.Distance from nearest building ------ -- --------------- ------- ------------- Remodeling and/or repairing (describe): _ �� ✓ r { ----------------------------------------- • . --- --- - ----- - --- - - - - -- --- ------ --------- 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)-------------- ------------------------ -- - -----` h _..,, ---s--- -- ------- - - ----------- -------- - (Owner and/or Contractor)� d.-----------(Title)- - (Plot plan, showing size of lot, location of systin relation to wells, buildings, etc., can be placed on reverse side FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY._._ ----- -------- - -- - ------ ------------------------ ----------- DATE------------ -------- REVIEWED BY-- -- - - --� �- ------- - ------ -- DATE..... BUILDING PERMIT ISSUED ----------------- --- -- --- -------- DATE__ -------------- -------- ----------- - •-- terations and/or recommendations------------------ - ---- --- --- ----- ------ . . FINAL INSPECTION BY.. _664 _-, .. .. ate... . D 'o � . SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E,Ha:eltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton, California Lodi,California Manteca,California Tracy,California F.P.C Q.