21226 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ---------------------------- - ----- _-a' --j APPLICATION FOR SANITATION PERMIT Permit No. �za (Complete in Duplicate) "---"""- ---------------=-------------- --- This Permit Ex ires l Year From Date Issued Date Issued 1//:7/7::i Application is hereby made to the San Joaquin Local Health District for a permit to construct and install t work herein described. This application is made in compliance with County Ordinancef No. 54 . JOB ADDRESS AN LOC TION__./ Owner's Na e - '• � � -- Address-____.-.- ._ D ----- - ---- --------- 4 ---- Contractor's Name._ �� --- 1 a"` !" -c----------------- ------ Phone-+ : Installation will serve: Residence [2� Apartment House ❑ ommercial Trailer Court ❑ ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms ___�___ Number of baths _ Lot size ___�' 7 ' — ------------ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table GO— ft. Character of soil to a depth of 3 feet: Sand [I Gravel ❑ Previous Application Made: (If yesdate.__.___._ Sandy Loam E] Clay Loam El Clay ❑ Adobe Hardpan El_.__-..-._) No El New Construction; Yes ❑ No. HA/VA: Yes [:] No E]TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank or cesspool permitted if public sewer is available within 200 feet.) Distance from nearest well_______________Distance from foundation-------------------Material______.___-__._..._.__.__..__________. J No. of compartments-------------------------- Size------_------------------------Liquid depth------------ --- ------CepacitY------------------- ie d Distance from nearest well. .Distance from foundation-Z�_-..Distance to nearest lot line____r Number of lines___...___ _ - -__Length of each line__ Q__- . i 4 , - --------- ..Width of ------- Type of filter material _. Depth of filter material-------�_ -_ .- 9 - _ Total length -------- -Q------ ------- \ Seepage Pit: Distance to nearest weIIt4Q_C __Distance from foundation---L f __-.-_..Dish Distance nearest lot line._._____-___--- Number of pits-1--------------------Lining material-P a Size:.Diameter___ # �]-"--.- "De th Cesspool: Distance from nearest well-----------------Distance from foundation_ __,..___.___\_ 1i'ring`materiaEl l_':,�_- _:° . ----------------------- f Size: Diameter. Depth --- ------ --------Liquid Capacity-,,..,,--------------------gals. Privy, Distance from nearest well Priv � - - - ------------ f-------- :.._ _ Distance.from nearest kiuildin G�1 �- ❑ Distance to nearest lot line----- ------------- --- - -- k 9V7 q 7717 Remodeling and/or repairing (describe):------------------ --------•------•------------•------------------------------------------- �/__9WZ0 -- --=' •.. - �� _:-------- -------=--- - ---•-----------------------•---------------------------------------------------------------------- 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, rules and regulations of the San Joaquin Local Health District. (Signed)--------------2ay_.*_ljig4t SEPTIC TANK SERVIdM ---------------------- - -------------- ---- Contractor) BY 291x£:EYFFner awe.. = }" 53FS8'$ - --- {Title) (Plot plan, showing size of lot, location of system in relation to wells. uildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY E ---------- 11------------------ --------------------------------------------- DATE--7 VIEWED BUILDING PERMIT ----------- DATE--- -------------------------------------------------------- ------- - - G -------------------- - ------------------------ --------------- //Al rations; and/or recom endations: ------ -------------------------------------------- DATE--------------------------------------- -------------------- -- - ------------------------------------------------------ ---•----------------------------------------------•------------- �� ' GZeree -------------------------------------------------------------------------- ----------------------- ------------------- ---- - c�°--------------- ----- FINAL INSPECTION BY: ---------- --- Date / � SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Harellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stocktonr California Lodi,California Manteca,California Tracy, California F.P.CO.