21425 - Laserfiche WebLink

Home Browse Search

f � _ FOR OFFICE USE: 1_4'= ' -`--- -- r APPLICATION FOR SANITATION PERMIT Permit No. 2 __/.. -------- l (Complete in Duplicate) 1- ---- ------ ------------------ -- Date Issued /.• .�� -------------------..-_. 11 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. ADDRESS AND LOCATI N__..113�_ -4 1134_.. r r, �t� t ------------------------------ JOB 3� -------- ---------------- __.__ Owner's N 13 --- -.CC Phone s � w� 7 Address.... -----� --- ------------------------------------------------------------------------ -------------------------------------------------•--•--...---.. ........... Contractor's Name �- J 7 S ------------------------------------------------------ Phone------------ ......---------- 7-- Installation will serve: Residence 0 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---Z__ Number of bedrooms 'f--- Number of baths -L._- Lot size ----'.�R ...... ... t---------------------------------- Water Supply: Public system ff Community system ❑ Private ❑ Depth to Water Table 4.5 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe L] Hardpan ❑ Previous Application Made: (If yes,date--------------------) No Ef� New Construction: Yes ❑ No 1j FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) SeptD' Tan�k- Distance from nearest well-----------------Distance from foundation--------------------Material------------------------------------.-.....-----. No. of compartments--------------------------Size---------------------------- --Liquid depth--------------------------Capacity----------------------- Disp I Fiel Distance from nearest well-----------------Distance from foundation-....._-.__..-_....Distance to nearest lot line................. pe�ee Number of lines-----------------------------------Length of each line---------------------------..-Width of trench-----.-----------------..--.-------- Type of filter material-------------------------Depth of filter material----------------------- length.________________________________________ Seepagg. Pit: Distance to nearest well---__ _.__.Distance foundation..Ffl..............Distance to nearest lot line--. ........._ �'a1.� Number of pits-_-_--_�-__-..--_-Lining material-."Iu'-�-�_... Size: Diameter-_-..�-�_� ----Depth__-0.2-'-------.--.- Cesspool: Distance from nearest well--------------..-Distance from foundation....................Lining material------------------------------------- ElSize: Diameter------------------- --------------- Depth-.----- -------------------------------------------Liquid Capacity------------------------•-gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-------.-----------------------..------.-. G► ❑ Distance to nearest lot line--------------------------------------------- ------------•-----------------------•-----------------------------------•----- - ------ Remodelingand/or repairing (describe):----------------------------------------------------------------------------------------------------•-----------------------••--------•----_-----_-- -------------•---------------•---------------------•---------•---------------------------------------------------------•---•--------------------------•------ ------------------------•------------•------------------------ j -------------------------- ------ ----- --- •-------------------------•-•-----•-•----•-•-----•-------------••-•-----------------•--•------------------------------------------------------------------------------------- w. 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 Joa uin Local Health District. __ (Signed)-----------------------------------------1- ----/ -- --- .......................... -----------------------. -(Owner and/or Contractor) By:----------------------------------------------------------------------------------------------------------------------------------(Title)_------------------------- --------- -------- - ---- --------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY...........,i.,j- ',", '----------------------------------------------------------------- DATE-----------1 --lllcl-�11--------------- REVIEWEDBY-------------------------------------------- ------ DATE------------------ ---------------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE--------------------------------------------- ...... Alterations and/or recommendations------------------------------------------------------------------------•---------------------------------------------• -------------------- .. ---------------------------------------- ----------- ---------------------------------------------------------------------------------------------•---•------------------------------------------ -----•-•-•-- -------------------------------------------------------------------------- ------------------- ----------------- ------------------------------------------------------------------------------------------ ------------------------- ----------- ------------------------- -------------------------- ----------------------------------------------------------------------------------------------------------- ----------------------------------- ------------ --------- ------------------ -------------------------------- ---------------------- ------------------------------------------------- ---------- �_�--------------- Date-------- ---- - r ~ ��J FINAL INSPECTION BY:.....��_--_-...... _� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West Stockton,California Lodi,California Manteca,California Tracy,C F.P.0 O.