21152 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ; --------------- APPLICATION FOR SANITATION PERMIT Permit No. 11 . - - - (Complete in Duplicate) -------- -- Da#e 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.T`(pt/7 n©5'— 2-&V ^u JOB ADDRESS AND LOCATION ---•---- �'-"'-°�`---& .�,-![r�_�- _ `�__'JCC Owner's Name-. ---- �. �d� I Phone Il AddressQ [ --- -- �: - -... -----------------------------------------------••--------------- Contractor's Name- L.. -- Phone-----••-----------------•-------- .------ ❑ �� Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer' Court ❑ Motek Other Number of living units: _ Number of bedrooms'--___- Number of baths J_4 Lot size __._____. ----------------------- II � ,- Water Supply: Public system ❑ Community system ❑ - Private [TE" Depth to Walter Table -------- ft. Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [Adobe ❑ Hardpan I Previous Application Made: (if yes,date--------------------) No ElNew Construction: Yes ❑ No E] FHA/VA: Yes Ll NcN4 .� TYPE OF INSTALLATIONANDSPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T k: Distance from nearest welY� _�..- Size 3Ce�fro m_x foundation uidldepth__Mayna4 f�itY � --------- _'--Liquid ---- --, No. of compartments_______ ______ Disposa Field: Distance from nearest well-_-.6-0__._Distance from foundation---I;19_- _____.Distance to nearest lo' ______ _-____. line Number of lines-----------I--------- -- Length of each line-----X-A--'E--------------Width of trench... _------.--------------------- 9 - T g Type or filter material_-____5--1______Depth of filter material__________ ._-.____ otal len th__ _________________________________ Seepa Pit: Distance to nearest well_..._/CC---------Distance from foundation--- Q...........Distance to nearest lot line---- ------- -- Number of pits ------ ----Lining material----g---a�-------Size: Qiat meter------- .- __._.Depth----- '----------------------- I I _._____Distance from foundation .............Lining material-_-...._.____-----.__..__-.__.____ Cesspool: Distance from nearest well----------------- _ LlSize: Diameter--------------------------------------Depth------------------------------------ ----------- Liquid Capacity - gals. Privy: Distance from nearest well_-----_-----------------------------------------Distance from nearest building---------------------------------------- ❑ Distance to nearest lot line------- ------------------------------------------------------�---------------------------- ------------------ ----------------------------- --------- Remodeling and/ t ----------------•------------- --------••--------------~------------•- or repairing (describe)_____________________________----._______--- ----------------------- -------------------------------------------------- -- -------------------- ------- --- ---------------- --- - ------------ - - ---------------- -- ---------------------------------------------- ----- ! I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count :r ordinances, State a�,+s, and rules and regulations of the San Joaquin Local Health District. 11 Si. ned _ l T -- - and/or Contractor) -- ------ ---•--------------- _ r { 9 ) --- ------ ------- ---- --: _ _ BY� ! -- -------------- -------------------------------------------- ---- - -- -----{Title)--------- --------- --------------_ -_ ------- --------- By:---------- - -------S----- (plot -- --- (Plot plan, showing size of lot, location of sy tem in relation to wells,'buildings, a c., tan be placed on reverse side). .r FOR DEPARTMENT USE ONLY a ! � APPLICATION ACCEPTED i3Y DATE- ---- -- -�-- 11 -- --- --- - - -- REVIEWEDBY-------------------------------- --------------------------- DATE t BUILDING PERMIT ISSUED----------------- ---------- -----------;----- DATE--- ------------------------- ----------------------------- Alterations and/or recommendations---------------------------------------------- ---------------------------------i---------------------------------------------------- ------------------------ •--------------- ------•---------- ---------- --------------------------------i------------- --------------------- -----------------------------------------------------•-------------------- ---------------------------------------- -------------- •---•-----------------------------I--------------------------- ----------- - -- ----------------------------------------------------- --------- �� '�Batef. - - - --------- - FINAL INSPECTION BY . -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT i bol E.Maxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street ' Stockton,California Lodi,California Manteca,CalI iforr is Tracy,California F.P.0 O. h