21546 - Laserfiche WebLink

Home Browse Search

POR OFFICE USE: , ----------_---------------- ---------.---------------!/.,'3d- APPLICATION FOR- SANITATION PERMIT Permit No. ------------ ---------------------------------------- -- (Complete in Duplicate) ...... 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 insta thew rk her escr•b . This application is made in complian with County Ordinance No. 54 1 7 JOB ADDRESS N LOC N. __ _ __. _ -- - --- -- --- -- - -- - -- ----------------- ---- ---- Owner's Name - --- --- ------ --------- --- 4.... .!.lam! ---------- Phon ---- -- -AddrAddress--------------- ess--------------- ----- ---------- ---- ---- ---eg-K---- --------;-------- C ~� -- --�-- ----•--•--•--------------------------------- Contractor's Name----------- --------- --- ----------------- -------- ------- Phone.44�A(e,417-7--- Installation will serve: Residencrre d Apartment House ❑ Commercial ❑ railer Motel ❑ Other E]Number of living units: -L____ Number of bedrooms _4___ Number of baths ---I--- Lot size ____;11--______C4�__�__`__%Q_------------------------------ Wafer Supply: Public system ❑ Community system ❑ Private X Depth to Water Table -8--- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam X Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date---------- ,___-----1 No`[vj-- New Construction: Yes E] No FHA/VA: Yes E] 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--$-�1�___ __Distance,from fpndation---M__r--__--Materia I____ _ _______________________ _ Il No. of compartments-------_ .._______---Size___3- -- --------------Liquid depth__.��_._._._._______Capacity_1Q0___—Disposal Field: Distance from nearest well_ Distance from foundati n. _;,V_._._._.Distance to nearest lot line__4Q l__� ._._.__Length of each line___ __ Number of lines__ g �--//�-(____..Width of trench._. �_r--____.___._____-__ Type of filter material__ -.- ___Depth of filter material___._ - 3_____-- g Total length Pit: Distance to nearest well----------------------Distance from jounclation------------------- Distance to nearest lot line---_--_-.-------. ❑ Number of pits----------------------Lining material--------------'--'. --Size:-Diameter--------------.--------Depth--------------------------------- Cesspool: Distance from nearest welL________________Distance from foundation---.---------------.Lining material____._.-_______._____________-_____. ❑ Size: Diameter--------------------------------------Depth------------------ ---------------------------------Liquid Capacity- '---------------------- -gals. I. Privy: Distance from nearest well---------------------------.------------------ ---Distance from nearest building..___.___.___.________________._..._----_. 1] Distance to nearest lot line- --------------------------------- "-------------------------------- --------------------------------------------------------------------. Remodeling and/or repairing (describe):` . ----- --- ___ . - --------- --------------------------•-------------------- ------••---- - -------• " fes- --� -� ---------------------------------------------- - = - I hereby certify that ave(prepared +his application and tha' :the work will be done in accordance with San Joaquin County ordinances, State laws, nd "ides:` ,aa_nd'rTergu ions of the San Jo uin1Local-Health District. (Signed)----------------- ---- ------ - - ---'-' ---- -.------- --------------------------------------- --(Owner and/or Contractor) By: `�-�`R' _: -------------- -- ----�._` _ (Title) ---- ........... �� __4 (Plot plan, showing size of lot, location of system i relation to wells, buildings, etc., can be platPdn reverse side). FOR DEPARTMENT USE ONLY _ t APPLICATION ACCEPTED BY__. � :_ " !��. _______________________________ . - ------ --------- DATE----�------- ---��.1 ---------'------------'---- REVIEWEDBY--------'------------------------------------'------------- --------------------------- -------------------------------------- DATE------------•----------------------------------- ------------ BUILDINGPERMIT ISSUED------------------ ----• -----------------------------------•-----------------------' ... DATE------------------------------ ----------------------------- d' 7 � 3v S.Alterations and/or recommendations: � _- �_ _- � " . .. _. -•---------------•---------------- ---------------------------- T--- ----------- ----------------------- ------------------------------------------------------ ------------------------------------------------- ---------- ---------- -------------------------------------------------------------------------------- •-----•-•--------------------------'--- ------ - ----• ------- ------------ ----------------- -------------•--------`-------------------------------- ------------ - ----- ---- --- --------------- --------------------------- ---------- --- -------------------------------------------------------•----- -- ---------- --------------------•--------------- ---------------------------------------------------------------------------------------------- FINAL INSPECTION BY:.-------- - ------ -- ' ---- ---------• Date----�Y 7---- -- '---- - .............................................. ----- . . SAN-JOAQUIN LOCAL..HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California