21604 - Laserfiche WebLink

Home Browse Search

OR OFFICE USE: 3 vy 114 - '?- / ----- --W4.,k/ A.'AwPPLICATION FOR SANITATION PERMIT Permit No. ... ........... 3 Z� ------------------------------------------------ (Complete-in Duplicate) Date issued —3--022-417 ----------------I- -- -- ---------------- -- --- ---- 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 w8k herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCAWN........ j ----- �� .J� -------------------------------- ........------------------------------------ Owner's Name-------------------- �41 ------------------- Phone.-•-•• --- ------ --- ------------------------------- -------------------- Address................... . ...... 5--/..........5-A. ------------------------------------------- ----------- ........................................... --- ----4........*_00 Contractor's Name._._.. 0 ------ ----------- ---- ---------------------------- ......... Phone.................................. Installation will serve: Residence (Apartment House Ej Commercial E] Trailer C4urt 0 Motel E] Other E] Number of living units: __j__-_ Number of bedrooms Number of baths ------- Lo, size -------- -------- -------- __- ------------------------ Water Supply: Public system M-1-Community system M Private E] Depth to Water'Table --- ft Character of soil to a depth of 3 feet- Sand E] Gravel F a " ] Sandy Loam [] Clay Loam ['`Clay [] Adobe [] Hardpan F Previous Application Made: (If yes,date------------------- ) No 1�+— New Construction: Yes Fj No El FHA/VA: Yes 0 No 0 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--------<:2---Distance from foundation---41��-------Material_-.------6P--- ------------------------------------- No. of compartments______.___?4__..-__Size___._---__-___._-_- -----------Liquid depth_________ -------- -I----- Capacity_../--:I-" Disposal FOd Distance from nearest well-_-.d......Distance from foundation--------------------Distance to nearest lot line..__..__-_____--- Number ine....----------- Number of lines_____-,-47 _ Length of each line-- --------------- ------------Width of trench------12L.-V- --------- Type of filter material --- Depth of filter material-----*-I-- �- CZ ---Total length---------- /-------------- T Seepage Pit: Distance to nearest well----------------------Distance fr foun tion....................Distance to nearest lot line._..._...._..__.. Number of pits.-------- Lining maferidi---- --- -- Diameter____,3. __3_ --------Depth-.------- --------- Cesspool: Distance from nearest well ....,-----------Dista ce from fo dation-_--_........_ ..Lining material-......____._--____.________--..-:___ ❑ Size: aterial------------------------------------ Size: Diameter- -- --------- ----- - ...... -------Depth-------- ------ ------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-___________________..._.-___-___-___-_._-__Distance from nearest building.__.-..__-__--_._____._-_-____----_-_-._. ❑ uilding.--------------- -------- ---------------- ID < Distance to nearest lot line -------- --------------------------------------------------------------------------- ----------------------------------------------------- ... .. ...................... --------------------------------------------------- Remodeling and/or repairing (describe):------ . - -------- --------------------------------------------------------------------------------t__T.... -------------------------------------------- -------------------------------------------------------------------------------------- -------------------------------------------------------------------------- --------------------------------------------- ------------------------------------------------------------------------- ------ --------- --------------------------------------------------------------_----------------------------------------------I--------------------------------------------------------------------- -------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St aws, and rul 'nd regulations of the San Joa uin Lo all Health District. ....... ... --------- -- ---- ---- ------- ---------- -- (Signed)....... . .............. .----- - ----------------.-(Owner and/or Contractor) ----------------- ------ ------- ...(Title)-------- .....--------- ---- ------- --------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc.,;can be placed on reverse Side). /-)FgR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- ---- ---- ------------------------------------- ------------- DATE_._� ---------------------------- REVIEWED BY -- -- - --- - - -- -------------- -- ----- DATF ---- - ....../ -------- --------- -- BUILDING PERMIT ISSUED- - DATE. ----------Alter tion and/or recommendations:----------------- ------------------------- ------ --- ------- ---------------------------------------------------........ --------------------------------- ---- ----- ----------------------------- ------------- --------------------I-------- - 2 ------------ ------------- ----------- ......... .....------------------------------------ ------------------------------- ------------------------------------ ------------ -------- --------- ------------I——-------------------------- Z1XA FINAL INSPECTION --------------------------------------- Date------ -------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton 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