21371 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: — I�d� l Int W DD& q --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ..,� .. ----------------------------------------- ------ (Complete in Duplicate) Date Issued ---------------------------------------- --.---_-------- I 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 the work herein described. This application is made in compliance with County Ordinance No. 549. i ii JOB ADDRESS AN O TION..1__ __ _ r� :-------- -_f-�----- t � � �� cur►�r� /� Owners Name--- -- --------- ------------------- - 1 hone...... Address. . -- --------------d-- --------------- ------------- ------ - i �y yf _ Contractor's Name----------- lf•1-ts ------i _. ...... Phone................................... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailers ourt ❑ `Motel ❑ Other ❑ Number of living units: _l----- Number of bedrooms ---/-.- Number of baths _1_--__ Lot size ---- Ut . -------- ----------- Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table .1 .. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [K, Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No 9- New Construction: Yes [� No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_/0,&_9__Dista fa ro �n� tion.-..-____._...___..Mater' I_____1 r f��( �a P - --- q p. Capacity- No. of com artments__ __.__.-_..-.._ Size -.__. _ _Li uid de th__..____ _ Dispo al Field: Distance from nearest well4_(XG1 Distance from foundatjon Distance to nearest lot ine�...��___-.- V I Q C7 Number of lines----- ..._ ____ ___.._ Length of each liner_-._._:_ _�.r_____.____.Width of trench.- - -_ __ - _ Type of filter material->'r_______________Depth of filter material.!_...__.--_-_-_____-__Total length---------�'Q:_.-__.__._...._-_------- Seepage Pit: Distance to nearest well-------_--------_-----Distance from foundation--------------------Distance to nearest lot line----------------- 1-71 Number of pits.---------------------Lining material._--_._-..----______.Size: Diameter-----------------------Dept h-_...__.-_---_._.--.__._-._.. Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material--------------.____._-_..._.___..__-- ❑ Size: Diameter--------------------------------------Depth--------- ------------------------------------------Liquid Capacity---------------------------gals. Li Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--__--_-____-_-_____--__-_--_-_.-__-_-_-_. C► ❑ Distance to nearest lot line----------------------------------------------------------------------- Remodeling and/or repairing (describe)____________________________________ , ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ---------------•-------------------•-----------------•------•-------------•---------------------------------•------•---•-------------------••--------------------------------------••--------------------------------- ------ -------------------------•---- ----•---------------------------------•--------- --------------------•----------------------------------- ------------- ---------------- ------------- I hereby ce y that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S e laws, and rules and reg`la�ions of the San Jo uin Local Health District. �`— - Owner and/or Contractor(Signed _-- _-_Title (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------------------------------------ ---- DATE------------------/--•-- ---- ` ---------------- REVIEWED BY-------------------------_------------------ _-- - . DATE----- —T/ - -- -----------_------ BUILDING PERMIT ISSUED------------------ D�t ATE------------------------------------------------------------- Alterations and/or recommendations:_-.C_O»S rkcI --- � o_QYEt .( a...- ?? I�S ....0 t .Y . '.._.__..____. ------------- f.� ...... 1P--j --- ---- T ------------------------------------------------ -----------------.--------- ------- �---- FINAL INSPECTION BY------ ------- Date Date - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California