21507 - Laserfiche WebLink

Home Browse Search

t/;q FOR OFFICES USE .._ Z -- ( �r,s �. G.. a rr APPLICATION FOR SANITATION PERMIT Permit No. .' ---S4 - --------------------------------- -- ------- (Complete in Duplicate) Date Issued _____ _ _____ _______ This 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 t e work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND"LOCATION _._rJEv .G t-------------�a ------------------------ JOB Owner's Name L r _, ll�'1i►.1/ ------------- ---------- Phone----------------------------------- ---------------------------- Address f� �f /��/ �/ Z ---r Contractor's Name____ ___ ____________ ------ Installation will serve: Residence A artment House Commercial Trailer Court El Motel 0 Other Number of living units: --/----.Number of bedrooms _- ._ Number of baths _�2__ Lot size ____: _______________ W Water Supply: Public system ❑ Community system ❑ Private [Depth to Water Table _ ft. (u Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [-❑ Clay dobe❑ Hardpan ❑ Previous Application Made: (If yes,date-- -----------------) No 2---'New Construction: Yes ❑ No �HA/VA: Yes ElNo TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sept'c T Distance from nearest well_________________Distance from foundation--------------------Material______.._____..._____..__________..__._._.___.__. AW11107 No. of compartments------ -------------------Size------•-------------------------Liquid depjh--------------------------Capacity-------------------- Disposal field: Distance from nearest well.3�U__-_Distance from foundation.__;3._�-_____.Distarnce to nearest lot line__�,0.__- /F •I Number of lines------- ________Length of each line____�!_Q-�_-----------.Width of trench.___�_�-----�..__---______ Type of filter material--S� ,�_ _Depth of filter material---� -._______.Total 4ength---- Q_________________ Seep^a�ge it: Distance to nearest well__Q 9__..Distance ,frgm foundation___ _ ------- Distance to nearest lot line_/..�_.___.. L� Number of pits-----/--.---_--_-Linin material__//ate_- -_ Size: Diameter---_ 3..._._._Depth----._-a_,5-_______________ Cesspool: Distance from nearest well-----------------Distance from foundation._..---_-.--.-----.Lining material-_._._._----___________._____._____ [) Size. Diameter--------------------------------------Depth---------- ------------------- -- - - - ------------Liquid Capacity----------------------------ga . Privy: Distance from nearest well-------------------_____..____._--- Distance from nearest building.__._..__..__________________-.-------- ❑ Distance to nearest lot lire-------------------------- -------- ---------------------------------------------------------------------------------------- - Remodelingand/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 laws, and rules a d regulations 9f the San Joaquin Local Health District. e Erelafion i A--------------------------------------P_e�_ O enc,/or Contractorl (Signed) { --------(Title)---- �x� .;..... . (Plot plan, showing size of lot, location of system innfowe�lls, uildings, etc., can be placed on reverse side). r.92FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- - c-- ----------------------------------------- ------------------ ---------- DATE '/4-0/4-7-- --------- -----_------ REVIEWED BY.-------------------------------------------------------------------------------- ------------------------------------------- DATE------- -- ----------- -------------------------------- BUILDINGPERMIT ISSUED-------------------------------- ------------------------------------------- ------------- DATE--------------- --------------------------------------------- Alterati n an or recammen a+ions:_____- -_--- e c x - ----- ---- ----------------------- ----- -------------- ------ --- ------------•-— ------ `-' - --�-----�`---------------- --- FINAL INSPECTION BY:..------. ----------- --- --------------------- Date- - - � -- .o14 --------------------------------------------- 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.CC.