22418 - Laserfiche WebLink

Home Browse Search

FOR OFFICE�JSE: -------------------- - ------------ ------- --------------- -------- _- --------lli_- _ _._ APPLICATION FOR SANITATION PERMIT Permit No. --------------------- - (Complete-in Duplicate) 7 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. This application is made in •compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATIOty<- _-CRIt-4`------A11Er A---'71- ----[-W.( R_PNy----I D--,---- -- -----------------�_F'! > --.- Owner's Name-------------_------jtw- .........h-I5l��7r - --- Phone.................................... Address--••-••-••-- ------8_1_t�. .N. ......R------- ----------P--(..� Contractor's Name------_&1,rN�R ------------------------------------------------- ------- ------ ----------------- --•--- Phone------_-••---------_---•-------- Installation will serve: Residence E Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ '___ Number of bedrooms__ Number of baths� Lot size ----- --�--__ A_Cf"R,>C'S_ ,=___._____--__._ Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table ------ _ ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam eClay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,-date__:- __-: Ea—_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___..../_-0___---�istance ater'al GY�/Ve".1� ______________ No. of compartments Size__ •_ _ _ P -! x�C--k--�'----Liquid depth -- - -z--------- Capacity-/,�'iC�p.... Disposal Field: Distance from nearest well--..5-Q'...Distance from foundation----/f!_�______._. to nearest lot line_____ ______ Number of lines______-_-_ -------Length of each line__ --------•------Width of trench..-------.—'�_6__".,,._________ Type of filter material CL- --__Depth of filter material-._-_f ��.---_--Total length---------------�-t-�_C2............. Seepage Pit: Distance to nearest well----------------------Distance from foundation-----•..............Distance to nearest lot line----------_---- El Number of pits--- ------------------Lining ------ Size: Diameter----____--------------Depth---------____................ Cesspool: Distance from nearest well________________Distance from foundation----------------- ..Lining material_-._____________--____-_____________ ❑ 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) •------------------------ --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State I , and rules and regulations of the San Joaquin Local Health District. (Signed)--------- ----------•-- ----------------------- - ---- ------ ----------•--= ---_ -------------- ------.(Owner and/or Contractor) \ By:... ---- -- - --------------- -------- ---------------------..._(Title)---------- . ...... ............. - ------- -- ----- (Plot plan, showing ze of lot, location of syst in relation to wells, buildings, etc., can be placed on reverse side). FOR DE!, &TMENT USE ONLY APPLICATION ACCEPTED BY---------R --------------------------------- ------------------- -------------- DATE.----- ."l�� -v�'>7----_----------- REVIEWEDBY------------------------------------ _------- DATE-----------•-------•--------------- BUILDING PERMIT ISSUED------ ------ DATE----_•----------------------------------- Alterations and/or recommendations:-------•--------• ------- -- ---- -----------------------------------------------------------------------------------•---•------•-------- FINAL I TION BY: - - ----- ---A_--- Date------ --/U." --� 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 E.H.9 2M 1.67 Vanguard Press