21117 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: --------------------------------------------------- ----- ----------------------------------------------- _-----__ APPLICATION FOR SANITATION PERMIT Permit No. .............. ------------------------------------------------------ [Complete in Duplicate] ��Dp _______________ __ This Permit Expires 1 Year From Date Issued Date Issuedlf -___3- �s 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 A LO ATION_ ` r vdo -/ ------- Owner's Name---A,-14W-- � t =�'►• l�f Phone Address------------ - -- ----------------•_--------- f Contractor's Name-,,,-= -- `2i -:�---------------------------- -------.._. Phone ✓w'?` � Installation will serve: "Residence [ tCpartment House ❑ Commercial [:1 Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-�___ Number of bedrooms___- Number of hhs __ ot size -_ t -t _t Water Supply: Public system E] Community system El Private Depth to Water Table ------ t. Character of soil to a depth of 3 feet: Sand ❑ Gravel El Sandy Loam ❑ Clay Loam Clay to Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date_.__-----.. _ 1 No ❑ New Construction: Yes ❑ No-k�—FHA/VA: Yes ❑ No E]. TYPE OF INSTALLATION AND SPECIFICATIONS: [No septic tank or cesspool permitted if public sewer is available within 200 feet�� Material..___ .._ ___ `.�`.`�'��___..____. , Septic Tank: Distance compartments nearest mel- -`_'_-/ Distance fro�Vfounation-�iqui�d depth__.__�_��......Capacity._____.___.__.________ } os iel Distance from rnear nearest well./ r-..._Distance from foundation- ff-7.Distance to nearest lot line__ .... Number of lines------�_____ _____Length of each line_1_Q.o_" Width of trench__ �s1_________________ Type of filter mater.i. ------Depth of filter materia!_----_ �f ___.__Total length___________________ Q_4_____ Seepage Pit: Distance^-#,nearest well----------------------Distance from foundation------------------- Distance to nearest lot line_________________ r^ ❑ Number of pits---.{-------._----Lining material-----------------------Size: Diameter.---•------------------Dept h-------:-------------------_---_- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------L':ning material-_-__-..._____..__..____.__________-_. Y ❑ Size: Diameter--------=-----------------------------Depth-----------------------------------------------------Liquid Capacity----------------------------gals, Privy: Distance from nearest well__________________________________ ___________Distance from nearest building--------------- -------------.___..---r-. ❑ Distance to nearest lot-line-------------------------------------------------------------------------------------------------------------------------------------------- t Remodeling and/or repairing (describe)_--------_--------- _______-_- :--------------------------------------------------------------•------------------------ ------------- : -------- ------- ------------------------------------------------ ---------------------------------- �--------------------------------------------------------------- = - --- - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State lawsxgpd rules and regulations of the San Aaquin Local Health District. //-tee Owner and/or Contractor [Signed}------------24--&-.-A-74t----- ------------ ------- ------------------- -- --- --- ------- -- -----------------------------------------------( / SEPTIC TANK SERVIG - ------(Title)-------------------- ------------ ------ ---BY2z}15 E:MItTBY Ave --- -- -------- (Plot plan, showing size el lot, ocati6n of system in relation o well's, buildings, etc., can be placed on reverse side). s FOR DE ARTMENT USE ONLY I APPLICATION ACCEPTED BY_ _ .r_ _ ______ DATE_ Q�_3_: --- ------------------------------------------------------------------- REVIEWED BY---------------------------------- - ---k :. -------- DATE----------------------------------------------------------- , - - BUILDINGPERMIT+ISSUED --------------------' ------------------------------------------------------------------------ DATE--- --------------------------------------------------------- Alterations and/or recommendations:--'---f-=-------------------------------------- --------•-----------------------------------------•------------------------------- ---- ----- - -- -------------- -----------•-------- --------------------- -----------------------------------------•--------------------•-------------------•--------------------------------------- U ---------------------------------------------------------------.:.-------------- ----------------------------------------------------------------------------------------------------------------------------------------•-- ----------------- ------------------ ----------- --------------------------- ----------------------------------------------- ------------------ ----- --------------•------------------------------------------------------- I -------------------------------------------- ---------- ----------- ---- FINAL INSPECTION B -.� r Date-- ---."r cc�J�.: 4 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 F.P.CA.