11427 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health District fora permit.to,construct and install the work herein described. This application is made in compliance elCounty Ordinance No. 549. t I I JOB ADDRESS AND LOCATION----- y� -- Owner's Name -------- F�---G21�.GSC-�---t--0-QZU-0 U 1TU-----------/-------------- I #- - ------ Phone ©_ r Address ................... •. ', p� °� - Fw_ - -S� : C Q Contractor's Name------ i PhoneInstallation will serve: Residence ❑ Apartment House ❑ Commercial ❑. Trailer Court El Motel El Other E]Number of livingunits: _I--- Number of bedrooms _f -Number of baths ____/_ Lot size___-_______________________ r1 Water Supply,: Public system E:1 Community stem'❑ Private F-1Depthto Water Table ________ ft. Character of soil to a depth of 3 fee+: Sand a t Gravel ❑ Sandy Loam [a_ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ k Previous Application Made: Yesl❑ No7E] New Construction: Yes ❑ No ❑ FFIA/VA: Yes 0 No ❑ 4 - . TYPE OF INSTALLATION ANE�SPECIFICATIONS: (No septic tank or' ce'400l permitted if public sp wer is available .within 200 feet.) r Septic Tank: Distance from nearest welL_----- Distance from foundation---------Matgr I _ .__ __.__._�_:____-.----_---. NoJof compartments___—___ ----------- Size ___i ]� Liquid depth____-��_ _� -------____Capacity_' .AIV I -f ,t r µ,' / � �_ - ___.__-. Length of each line______'��'� -------Disposal EK trench___ Distance from oun anon__-_ - i r ( -------------- Type of filter matenal _______ ,G__.___ Depth of filter material____.l __..._Total length._____av_____________________________ Seepage Pit: Distance to nearest well ---------------------- Distance from foundation ---------- ---------- Distance to nearest lot line ____.__________._ ❑ Number of pits ------------------ ---- Lining material ----------------------.Size: Diameter ---- -----------I------ Depth ------------------------_-------- Cesspool: Distance from nearest well ----------------- Distance from foundation_______ ------------ material_________________________--_________- --------------- Depth ----- .__ - 1 - ----- Liquid Capacity ---------------------------- gals. apacity----------------------------gals. ❑ Size Diameter--------------------- p �---------------------------- Privy: Distance from nearest well ___________________________________;------- ---- rom nearest building------------------------------- .---------. ❑ Distance to nearest lot line-----------------------------------s---------.-J - -y 1--_ -- # ---------------------------------------------------- --------------------- Remodeling and/or repairing (describe):----- ------------------------------ ------- ------------ ------------------------------------------------------------ t ----------------- a I ;ti . i i ------------------------------•-----------------------------•----------------------- ---•--••--------- ! # 1 I hereby certify that I have prepared this• appl' atc� ion and that ;the work will be done in accordance with San Joaquin "County ordinances, State aws, and rules and regulations f the San Joa uin Local Health District. r t ` -�-ri ----- -------- }--�}-'"a'---�----------------- !'_ O a. (Signed). -----•- -- --- -- - - - - ---- ------------ ----- ( d/or Contractor] n Y ( -------------------------------- ---------------------------------------- ------------------------------------ . - Title (Plot plan, showing size of lot, location of system in.relation to wells,, buildings, etc., can be placed on reverse side). -- E # FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY----------- --- 11 - - ------------------------------------- DATE------- =C REVIEWED BY -------------=- F--------------------- -- - DATE BUILDING PERMIT ISSUED -------------- DATE = - Alterations and/or recommendations:__�}es-7-:___,rvSt-1 ?7-/�1___� �'ct� i aR-____. ��rrQ--- "T�f��_..Fa�- 77 oq-------- --------------------------------------------------- ------ ------------------------•-------•-------_-------- ----•------•------------------------------------------------------------------------------••-•------------------•--------------- - I : r FINAL INSPECTION BY:._'rX_ ------------ -- +� . Date ---- 7_A6�------------ ------------------------------------ SAN JOAQUIjN.LOHEA TH DISTRICT 130 South American Street Stockton, California ES -9-21x1 , Reviseci 1.57 F.P.CO. 300 West Oak Street 132 Sycamore Street 814 North "C" Street Lodi, California Manteca, California Tracy, California