18602 - Laserfiche WebLink

Home Browse Search

FOR,FFFICE USE: T -------------------- ---------------- --------------- ------ _ APPLICATION FOR SANITATION PERMIT Permit No. ...IaF O Z -------------- -- i Duplicate) -- - --------------------- �- ---- ---- ----------- (Complete In Du licate -------------------------------------------- This Per mft Expires 1 Year From Date Issued Date-Issued _3,�J� 6 ----- s 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. M TG JOB ADDRESS AND LOCATION �� --�� ------- V. 10 r / t-u. Q_:. D Q lJ l Owner's Name---------------- JI.A�__N_ - ----VI1.•�!-u.1�------------------------------- --------------- Phone.111'3_'_..a)_q-?S Address_________ ___ _- Contractor's Name--- ...................Z1-4 -------j6 , 5r`- Phone. Installation will serve: .,Residence [!r Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __!--__ Number of bedrooms 2...._ Number of baths j_.__ Lot size •-___�p ._. .---�SQ_---_. # Water Supply: Public system ❑ Community system ❑ Private 59/6epth to Water Table A? ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: _(lf yes,date--------------------) No New Construction: Yes [3-IN"'o ❑ FHA/VA: Yes ©'�No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) -` Septic Tank: Distance from nearest well----- .�?.___Distance from foundation-----A -------Material_ No. of compartments_.___.------------ Liquid depth---f� --------Capacity__ffl___ ` Disposal Field: Distance from nearest well _5' _-Distance from foundation - _.Distance to nearest lot line___,-!- [ - Number of Lines---------/--- -_ ...__ Length of each line-_-__�,.------------------ " --- Width of french of filter material-- �F'OK-._Depth of filter material__ _1.9'_' -----Total length------------��____'_ ------------- Seepage Pit: Distance to nearest well_ ._ -__-_. _--___Distance from foundation.___-__•-___--.___Distance to nearest lot line_-__-..___. .. ❑ Number of pits------------- Lining material----------------------Size: Diameter------------- ---------Depth--------------------------------~ Cesspool: Distance from nearest well-----------------Distance from foundation------------------- material---------------------------- _.... ❑ Size: Diameter------------------ ------------Depth----------------------------------------------------Liquid Capacity----------------------------9als7 Privy: Distance from nearest well----------_--------------------------------------Distance from nearest building------------.--------------- __--..__.. ❑ Distance to nearest lot line___..______.___._.__.:._.__-_-_----_______________________ Remodeling and/or repairing (describe)_--------------------------------------------------------- , ----------------------- ------------------------•----------•----------------- --•------------ ----------------------------••------------------------- ------ --------------------------------------------------------------•---------------•------ --------- ----------------------•----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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 a d regul4a ions of the San Joaquin Local Health District. (Signed)- •----- ------ - ......... ------ -------------------_ --------------------------------------------------------------------------(Owner and/or Contractor) 0 B .. . Y� ----------------------------- ------------------------------------------------------- -------- Title __ __ _ _ (Plof 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_-------_.!_-t_K_0' --------------------------------------- DATE---------- 2.- -------------------------------------- BUILDING T�� ----- -- -- --- - - y __ ____ ________ _ _ REVIEWED E -- -- IS ----- DATE- - ------------------------------------------------------ DATE -- ------------- -------------- -------- ------ BUILDING PERMIT ISSUED - DATE----------------------- Alterations and/or recommendations:___.__._____...__.__..__ ------ --- --- ---- -- -------- --- --- --- -........... --------- ---- ------- -- - ---- .. FINAL INSPECTION BY Date --- - -�_ ��- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CC.