22657 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ----------------------------- --- ----------------------- APPLICATION FOR SANITATION PERMIT Permit No. .. a.i -...- L_� (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 AND LOCATIONlAIA®G -N-Wv ------------------------------------- 7110", --- --------- ------------------ Owner's Name-------------------�1-- — -- ©---------------------------------------------- ------------------------------- Phone7`411. 3. Address----- ------ ,r �iflt! e. US3'f/'Y-/ ?/1 .-r 'f� 7r � � '---------------------------------------------------------------- Contractor's Name----- Lt� fr ------ Phone.------•------- ----=----------•-- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: -------- Number of bedrooms/----- Number of baths --/--_ Lot size-.240.X0?Z- - ------ -----•-- Water Supply: Public system ❑ Community system ❑ Private UKDepth to Water Table/V--_ ft. Character of soil to a depth of 3 feet: Sand eGravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date-.----_- ----------) No [!T" New Construction: Yes P9--No ❑ FHA/VA: Yes ❑_ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) s p� Septic Tank: Distance from nearest well-�--- ----- Distanncp f rom.f ndation_/C.___.--..-..Mater ialcOK4c7r.f----— � • �/ No. of compartments_---Z--------- -----Size._?° ...... . _. Liquid d;pth_, -----------------Capacity Q.Q._ Disposal Field: Distance from nearest well-_ _._---_Distance from foundatior�3---------.--Distance to neare�sstulo�`line_'�Q_�r Number of lines_-_-_-..___/_ _Length of each line,/--Cc------------------------Width of trenchers_------_-:.._--_----.--_-.---- ❑ -------------" 10 < Type of filter materiACK Depth of filter material-_�.1...............Total length_��L? 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----------..-__.---.Lining material---.-.--.---_.----.-.---.--------._._. 171 Size: Diameter------------------- ----------------Depth-------------------------- --------------------Liquid Capacity--------------------- gals. Privy: Distance from nearest well -_-_.---_..----------------------------------Distance from nearest building---.-._---.-..---__-_----_------.-.-__. ❑ Distance to nearest lot line------ ------------------------------------ ----------------------•-----•-------- ---------------------•-------- --------------------------- Remodeling and/or repairing describe) T�.�,4146t1f. —4 ------------------------------------------��-----��-`Ao --C 1-z4swrJ--------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------- - ----------- - -------------------------------------7---------------------------------------------------------------------------------------------------------------------------- ----------------- 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. s (Signed)------------- ------------------ ----------------- --------------------------------------------------------------(Owner and/or. +0; _. 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----- ---------- t �w' --------------- ------------------------------------------- DATE------ "� V---------------- - REVIEWED BY--------------------------------------------- -------------------------- ------ DATE----- ------------------------------------------------------ BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------- --------- DATE----------------------------------- ----------------------- Alterationsand/or recommendations------------------------------ ----------------------------------------------------------------------------------------- -------------------------------------- -------------------------------------------------------------------------•-•--- ----------------------- --------------------------------------------------------------- -------------------------------------------------------------- ------------------------- ------------------------------------------------------- -------------- ---------- --------- --------- -------- - ------------ ----- ---- -- - --- -------------- ------------ ----- FINAL INSP Date_..-_1. .` --'- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 20S West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.0 0.