21581 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: . ., -----.- ------ --- - - --------------------- --.- APPLICATION FOR SANITATION PERMIT Permit No. .__. - � l (Complete in Duplicate) • Date Issued ..... -�l✓.�_'"Y 7 -------------------------------------------------..--------- This Permit Ex fres 1 Year From Date Issued 7 - Application is hereby made to the San Joaquin Local Health District for a p rmit to construct and inst�7hwoWherein described. This application is made in compliance with County Ordinance No. 549. _ "J JOB ADDRESS A OCATION. t--4---Q4-'---7-- -- ----------- - ----------- " Owner's Name---- .. ---- -- --------- - -- - - --- -- ---- ------- Phone- -- ----- ---------- Address----------Qr� ci-.--c��-� _- _------------ / Contractor's Name__ t-�_ --------- -----.--�u...�� ______________ Phone- -sf _l Installation will serve: Resiclence��partmenf House Commercial ❑ Trailer Court E] Motel ❑] "O"ther ❑ Number of living units. ___/_ Number of bedrooms___ Number of baths /:__ Lot size _tet (, Wit__ ----- ------------------- ---------------------- Water Supply: Public system ❑ Community system ❑ Privateepth to ter Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay Adobe ❑ Hardpan,a.+ Previous Application Made: Ilf yes date .,_{.�fo_� No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No Q TYPE:OF.INSTALLATION AND- SPECIFICATIONS: (No septic tank or cesspool permitted iffblic sewer-is available within 200 feet.) is Distance from nearest well-----------------Distance from foundation____________.____.Material---------------------------- -------------- -;—"No. I -------------- No. of compartments - JSize Liquid dept Capacity osal field• Distance from nearQst well _ ._Distance from foundation._- ____Dis#once to nearest-lot lirie__ ___( 4 Number of lines____1____ Length of each line__6_.�_________._.Width of trench-ca�_5__C...__. I � Type of filter materia Depth of filter material-----ZIFI 0-----Total length------------------------VftJ---------- _______________:____--(CN_______._- �n Seepage Pit: Distance to near well_____________________Distance from foundation---..-----__....... Distance to nearest lot line----------------- ❑ Number of pits-- -----------------Lining .material-----------------_{----Size: Diameter-----------------------Deptb--.------------------------------ Cesspool: Distance from nearest well--------- -----Distance from foundation------------------Lining material---------------------------------------- ❑ Size:,Diameter-----=------------------------a_ Depth---------------------------------- „-----------Liquid Capacity------------------ ---------gals.1 7w Privy: Distance from nearest well _ .-�--- I------------------- --Distance from nearest building--------_________________-__..___._._._.� ❑ Distance fo nearest lot line'.. --------------------------------------------------------------------_ 4 "1 .: Remodeling and or repairing d--SfC ril�� e)-------------------=---: -------- - - -- ------ -------- •---------- ---- ---------------------- ------------------------------- - ---- ------- - - --- - --------------- ------------------- - ---------------------- -------- ----------•--------------------------------- ' ------------------------------------ -------------------------------------------------------- ---------------------------------------------------- ----- Iherebycertify that ( have y prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St a I s, an rules and regulations of a Joaquin Local ealth District. j ' 1 � ____ (Signed) xi ------------------------------ �r Cont ratfor By --, - - :- - - ------------- a}'.-------�`-- .. `r "R='-'""„ 3 (Plot plan, showing size of tat, location of system in rel on to wells, bu' ings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- t -- ------------------------------------------- ----- DATE.----- > -/1- --------------------------- REVIEWED BY------ ------------- ------ DATE BUILDINGPERMITISSUED----------------------------------------------------------------------------------------------------- DATE--------- ----------------------------- - ------------------- Alterations and/or recommendations:i--------------------- -------------------- ---------•--------------------------------------••-------------------------•-•----------------------------- -- ------------------------------------ ---------- -- ------------------------------------------------------------------------------ ------------------ --------- ----------- FINAL INSPECT N B Date-------- '.J Y ? } SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi, California Manteca,California Tracy,California F.a.Co.