20201 - Laserfiche WebLink

Home Browse Search

/IR OFFICE USE: ----------------------- -z ------_ APPLICATION FOR 1.SANITATION PERMIT Permit No. Q..____ -1 Com lete in Du licaterl Date Issued ___.___---____k- f ` -z-------------------------- P A c� a ._..- This Permit Expires 1 Year From Date Issued r ' 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 Ordinancce`No. 549. JOBADDRESS AND LOCATION_-, ------------------------------ ---16--------------------------------------------- ----------------------- Owner's Name------- 1.5 F ' `" j ri Address1 lade_ �-f V-0. a --- -•--•-------------------------------------•--------------•------•-••---------•------ �•-� ..G Phone------------•---------------------- Contractor's Na -----'�------- _- ;,- -,e / -- , 4 Installation will serve: Residence [�Apartnlenf House ❑ Commercial ❑ Trailer Court E] ' el ❑ °It Other L] Number of living units: Number of bedrooms __•.Number of baths __/__ Lot size __ pa _�X- -1_5� ---`--------- Water Supply: Public system [i�Community system ❑ Private ® Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ® Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date-..-----------------) No 5E New Construction: Yes ❑ No ®- FHA/VA: Yes ❑ No [ TYPE OF INS'TAL,LATION AND SPECIFICATIONS: f (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well------- -------:_Distance from foundation-------------------Material----------------------------------.._........-... ❑ No. of compartments--------------- -- -------Size--------------------------------Liquid depth------------- -------- ---Capacity----------------------- Disposal Field:- - Distance from-nearest-well.:...............Distance-from foundation__-�O__ ___._.Distance to nearest lot line______ 00 Length of each line_ Number of lines----------- ---- ----- ?�----------•---- Width of trenc -- . h. - _-- Type of filter material__5�J4t�/ .,Depth of filter material__ ��_...___Total length__________fe_--__________________ Seepage Pit: Distance to nearest well_- �_______Distance fro #oundation_A--____.Distance a� to nearest lot LiDepth s s Number of pits-_________�_......__Lining maten -al..� ��5ize: Diametet__, ,�_____..____Deptn____.._�______________ V% ' Cesspool: Distance from nearest well._______________Distance rom foundation---.------- ----- Lining material------------------------------------- Size: Diameter--------------------------- --- -- ------- - ------------------Liquid Capacity-- -------------------------gals. ❑ Depth----------------------- Privy: Distance from nearest we1L._.___________________________________-____�istance.from nearest building._-.______._______.__________-------_--- Ib ❑ Distance to nearest lot line-- t t ---------- --------- ------- - --------------- --------- - Remodelirf ' and/or repairing describe '.__ 1 �? . -�J fP__ �--•---.----- -5-- ' ------------------------------------------------------------ -------------------------- ------------ I! _____________________________________________________________________________________________________________________- ___a_______ _____ __ ____-----I-____�1-------_--------___.___.___________________---- I I'hereby certify that I have prepared this application and that the wor i e , ane in accordance with San Joaquin County ordinances, State laws, and rules an (ions of the Sant . uin ca Health District. i x � (Signed}--------•--_: ..� � ' ._��. ae or Contractor} By:------ - -------- - - ----- - - ---------------------------------- -----------'----------------------------(Title}------ ..�1. II (Plot plan, s g size o lot, locafi of system inrelationto wells, buildings, etc., "an be placedon' reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- ------- ------ - ----------------------------------------------------------------- DATE ° ft. ----------------------- -------------- REVIEWED 'BY. -----i----------------------------------- IDATE BUILDINGPERMIT ISSUED------------------------------------------------------------------------ -------- ------ DA-TE----------------------------------- -------- ------------ --- Alterations and/gr recom en atios:_ _ ----------------------------------------------------- - - � _._.. -----._ � _71 ----------- ------------- - _ ----------------------------- ---- -- --------------------------------------------- f/ ' --------- ---- `` �" i_.16 — ------------------------------------- •- - t I - l FINAL INSPECTION' BY------ ----------------------------- ----- Date- ` SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodir California Manteca,California Tracy,California a.P.co. k