21350 - Laserfiche WebLink

Home Browse Search

run �rrlc.t u5t: . --- ----__.----q"_;�o---- APPI_ICWTION FOR-SANITATION PERMIT Permit Nb. (Complete in Du`llicate� x------- ............. --------- --- -- This Permit Expires 1 Year From Date issued Date Issued la_.:- 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 _ - - - �.,.._,... .._. --- 'Owner's Name- '€ ": � " - ------ _- ------ - - Phone Address � �� - '✓ "moi' o �^ --•---- Contractor's Name- .- ' -----•------------ -------------------------- Phone..V'�P-gMa7------ Installation will serve: Residence ® Apartmont House ❑ Commercial ❑ Trailer Court ❑ Motel 0 Other ❑ Number of living units: __1---- Number of bedrooms Number of baths --.-I--- Lot size _.1 _-k` 1 ____________________ Water Supply: Publics stem Community system 4 I Y ,Q y y ❑ Private ❑ Depth to Water Table-.. _..- ft. � Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loamm 0 Clay Loam ❑ Cl ❑ Adobe.-(H Hardpan ❑ Previous Application Mede: (If yes,dote_`J..'.-� -_ ..] No New Consfructio%. Yes © No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tankoor cesspool permitted if public sewer is available within 200 feet.] I tt e Septic Tank: Distance from nearest well-104 -.--Distanc )f o foundation__-� -'-._----_.Material_`_: 'p __ _f- --.._---___ No. of compartments Size ��' - Liquid depth. Capacity--&---- Disposal ,1 Z-21).1 d + I Field- Disfance from nearest well---7Distancel from foundafi'on_-ZLt-----------Distance to nearest lot _`.-- ® Number of lines________ ------____---_______Length-of each line-__-t1 --'---________Width of +Tench..---� .!✓_- Type of filter material-_�R.C4----------Depth of filter material--_�----- -------Total length-------qV-:------------- Seepage Pit: D: tance to nearest well_---L-�-- -____Distance from foundation-_ -Q-_______-Distance to nearest lot line--f�'_-.._. ® . x ab .� Depth .--. .> - P Number of pits-- 1------------_Unirn'g ma#anal:_:.-,�fiiF2 'Size: Diame#er-- � Cesspool: well 'found -- Distance from nearest well----------------Distance from foundation___--:_._.____..... Lining material __....-_-----_----___-._____.______: ❑ Size: Diameter - '---.lDepth-----------------------------{ -------------------Liquid Capacity--------------- -------gals. Privy: Distance from nearest well-------- "-_I------- ---------------- -Distance from nearest building ❑ Distance to nearest lot I`me--- - f--------------------- 4 ---i-------------------------------------------------:------ --------------- --------- Remodeling and/or repairing ____________________ --------•------•------------------------------------------------ �. --------- ---------------- ' --------------------------------------------------------------- --------, - , - --- ---------------------------------- - --------------------------- - �.. i I hereby certify that I have prepared this application4and 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. .die b� (Signed)--__ ---- ------------------- - -----(Owner and/or Contractor{ (Plot plan, showing size of lot, location of system in elatrioit�to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----------- DATE------ - ------------- REVIEWED BY---- ------------------------------------------- --------------- --------- ------------------------------------------ ---- DATE-------------------- - ----------------------------- BUILDING PERMIT ISSUED-------------- ---------•--------------------------------- -- ------- DATE------ ------------- Alterations and/or recommendations:.---- l .-_O_lf=- ----q-+--•---Zr---------- J--- /Zl�/�G ---------------------------- ---- ----------------------------- ------------------ FINAL INSPECTION BY:............---fly-_- s- / �j --- Date---------- ` / ��i ``6 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