21289 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: d APPLICATION FOR SANITATION PERMIT Permit No. .. .� - � ---- ---------------------- ------------- - ----- (Complete in Duplicate) Date= Issued ___ _____ Tftis 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 Or ante . S49. JOBADDRESS AND LO -Y I I -------------------------------------------------------------------------------------- Owner's Name------ -- -- - --- -- `--.�-.- -- - - -• -- - - -- - --- -- --------------- Phone---------------------•----------- Address...----------------•-- -- -------- ---- -- -------- ---- ---------------------•-••--------------------------------- f Contractor's Name ' �^ -- ��+ Phone Installation will serve: Residence &--,�partment House Commer lal ❑ Trailer ourt ❑ Motel ❑ Other ❑ - Number of living units: __!-.__ N ber of bedrooms _- umber of baths ./-__ Lot size _, '----?�-- -- .-er------------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table 6vft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: (If yes,date-_.................) No ❑ New Construction: Yes ❑ No -FHA/VA: Yes ❑,F No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) C Tan Distance from nearest well-,� Distanc from fon at on__�!l______-_..M I--� _ _ __ .__ 1i . r+. - . No. of compartments--.1---------------------Size3_� �..Liquid depth-_- CapacttY .____.__ /�r �, Di os 4d: Distance from neare t wellA_a�,Q.,.._.Distance from foundation-._ _ 1r!.___..__.DlStdnCe to nearest lot-line------- ------- Number of iines______. _ _� -Length of each line---_-_ --jV-e-------------Width of trench.-4�'�f_-�.-----_----- De th of filter materia___-. .--- Total length---------------/ ,___:-----_----- °� Type of filter material ��!� p flr� Seep ge Pit:. Distance to nearest well_I h'T)�kl._c..Distance f om foundation_---_ _-__ Distance nearesf lot line��__._ Number of pits.__!---________----Lining materiel-_ _ _..__.Size: Diameter.__ _.._._.Depth--_�i t, _________________ 4 Cesspool: Distance from nearest well----------------- from oundation-------------------Lining material____..-----------._.--_---.-----._-__.f ❑ Size: Diameter-------------------- - --------------Depth---------- ---------------- ---------=-----Liquid Capacity---------- - -----gals. kPrivy: Distance from nearest well___-------------______-_----.-----------_--._-..Distance from nearest building_------------.._______-_-:----------.__-. : ❑ Distance to nearest lot line-------------------------- ----------------------- -- --------- S � r Remodeling and/or repairing (describe)--------------- --- --- --- ---- - ------ - ------ --------------------------------------- F ------- _ __________k_.____..___________ _ __ _ ________. ---_ --- __-_ _ _ _ __f___ ___ - _ _ --------------------------------- - _-----___-----___-_-_----_.__ !. _..___ _ ___ ._______._r_ _ _ _ ____________ ____ __________ _________-f-___-_____-_----_ _ __-_-__-._---------_-_-___-__-_----__ _---___-__---_---__._____--_---____-_-----_._----__---_-------____--_------_--_.__-_-_-_...._--.-._-__._---_---------_ 0 I hereby certify th Fhave prepared this application and that the work will be done in accordance with San Joaquin County ` ordinances, State laws dryr�ules and regulations of the San Joaquin Local Health District. �Ua ---�or Contractor] f (Signed) �� ------------------------------ TAI�IK S�2V7C�E --�---------------�-�job By:Z9-15.E,_MinerAye:,__._HO,6.384fl--------------------------- - --------- ---- --- --------- -- .---ITitle).............._-=-------------- ------ -- - (Plot plan, showing size of lot, location of system in relatioells, buildin etc.,-can be placed on reverse side). FOR DEPARTMENT USE ONLY , • tom' APPLICATION ACCEPTED BY - DATE '`` r .l . REVIEWED, , BY----- --------------------------- ------------ ----------- -------- ------------ ---------------------i- --- DATE--------------------------------------------------------- BUILDINGPERMIT ISSUED----------------------------- ----- DATE------------------------------ --------------------------; Alterations and/or recommendations:-___-- f r - •+�--'--- ---- -`yam---------- -----? --- ------ -------------=--=-------------------------- ---• --------------- -- ------- --------------------------------------------------- -- V '147 --------------------- �. ---- -2, / --------------- '�1.`✓h_�✓.... . i-- .. r�^- -�- -�------ - ------ FINAL INSPECTION BY:_ -------- . . ..... bate_...... ------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CC. t.