22457 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: '----------------- �D-__fid_-:_I�_ __ ------------- __/_6- APPLICATION FOR SANITATION PERMIT Permit No. 12 ----------------------- (Complete-in Duplicate) �-'7 0-------- - 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. 1( 601 JOB ADDRESS AND LOCATIONC-'�r+ - a Owner's Name__ - ------------------ ------------------------------------------ Pho� r•��-� �. Address -------------------- - -------- ------------_- ---------- Contractor's Name Phonr� ------------ - Installation will serve: Residence Apartment House [] Commercial ❑ Trailer Court E] Motel ❑ Other ❑ Number of living units: _Cr_____ Number of bedrooms �Z_. Number of baths_T-•--- Lot size /^ Water Supply: Public system Community system Private ❑ Depth to Water Tablet/ 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 ❑ New Construction: Yes ❑ No4)6_ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se ti Distance from nearest well-----------------Distance from foundation--------------------Material No. of compartments------ ------Size----- --------- ---•-------Liquid depth--------- ------- ------ Capacity-------------------- Disgosal Dis osal Distance from nearest well ----Distance from foundation.- Distance to nearest lot line-__ 9 -_ a �Q Number of lines___ ___-- _ _ Length of each line__ Q_�_.__. ___-Width of trench.-,� q N Type of filter materia Depth of filter materia____./ /___Total length_____.___-----_--- �_ _ Seepage Pit: Distance to nearest well__tA_GbL- _____-Distance from foundation_.2.-Q--------Distance to nearest lot line__-----G� Number of pits.-- f ------------__Lining material __1;?,.©_ ----. Size: Diameter-_C!5 ------Depth_,I.�/------------------ Cesspool: Distance from nearest well --------_------Distance from oundation;- ------------- _.Lining material--------------------.______--______ ❑ Size: Diameter. -- ------------- ----------------Depth---- ---------- ------------------------ --------Liquid Capacity- -----------------------..gals. Privy: Distan�C'Rlrom-nearest well------.-----------------------------.____._-__Distance from,.nearest building------------------- _____-____--_.__.. ❑ ... Distance to nearest lof fine Remodeling and/or*repairing (des'tribe): .----- \ -------- ----- �9 - -- b' 1 - - . I hereby certify that I have prepared this application and that tlwork willbedone in accordance with San Joaquin County ordinances, State laws, an les and regulations of an Joaquin L c I_HeA Fh District. (Signed)_ --May & plyAt ----- - t SEPTIC TANK->$ERVICE on rector) BY:------291.5€.Miner.Ave, .HD._5:3041_ --- - ----- - --------------(Title)--- (Plot plan, showing size of lot, location of system in r ion ells, buildin , etc., can be placed on reverse side). F PARTMENT USE ONLY APPLICATION ACCEPTED BY----------------- --- -- ---- -------------- DATE ----------------- V- REVIEWED BY------------------------------------- - ---------- ------------------------- ---------------------------- ------- DATE------------------ ------------- UILDING PERMIT ISSUED-------- -- ------------------------------------------------------------------- --------- ----------- DATE - Alterations and/or recommends ions: - r---- ---------- -- ------ ------- --------------------------------------------- ------------ l�' j' : 1= t s--7Za-1------� ------------ -------- --------- -, ----------- - ---------------------- --------- --- - ------------------------ ------------------- - - ---------------------------- ----------------------- --- - ------------------------------------------ FINAL INSPECTION BY: j - - ..... �=----- ------------------- Date.------ 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