22160 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. . a�. © --------- --------------- ------ --- -------------------- (Complete in Duplicate) pp-- .- This Permit Expires 1 Year From Date Issued Date Issued Cl---�,7� , 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. - - ------ Address IY - 549 JOB ADDRESS AND—LOCATION—P---,--,3---kax--�--O-J -�+ - -- nPho_Qn2e --------�---,-i----�--- -------------- Owner's Name------- Lep --•-• Address-----� } � -------- Contractor's Name � ----------------- Phone---------- ------------------------ � -- �---- ' �C - -- --------------...--------------------------------------------------- - % Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ t Number of living units: _ Number of bedrooms -j- Number of baths I____ Lot size ------��_�L-��_�______________________________ Water Supply: Public system ❑ Community system ❑ Private'QDepth 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--------------_----1 No ❑ New Construction: Yes ❑ N ) ----Ft-IA/VA: Yes E] No E]TYPE OF INSTALLATION AND SPECIFICATIONS: �� (No septic tank or cesspool permitted if public sgwer is available within 200 IF feet.} �, Se tic Tank: Distance from nearest wet ----Distance from fou dation__ ----_-_.M to ' It _ _ _ No. of compartments---_!�_____________Size_ j _ _� _Liquid depth___�_..�-------Capacity....1 �___ Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line____________..... Number of lines-----------------------------------Length of each line------------------------------Width of trench----------------------------------- Type of filter material--------_-----_----------Depth of filter material-----------------------Total length---------------._:--___.__________________ Seepage Pit: Distance to nearest well______----------------Distance from foundation--------------------Distance to nearest lot line_____--_______-__ ❑ 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. Privy: Distance from nearest well-----------____---------------------.._- _Distance from nearest building----------------------------------.___._- ❑ Distance to nearest lot line-- ----------------------------------------------------------------------------------------------------------------------------- ------------- Remodeling and/or repairing (describe)--------------- ---- ------ - -------------- --- --------- ------ - --- -- ----- - ---------•-----*---------------------------- ------------------------------------- ------- ----------- ----- -------- --- 1 - - ------------------------ ------ ------------ ------------- - ----- ----- { ----------------------------- --- ----- -------------------- --- --- ------- ---- --- --- - --- ----- ---- --------------------------------------------------------------------------------------------------------- I hereby certify that Ijjve prepared this application and t at the work will be done in accordance with Sara Joaquin County ordinances, State laws, an es and regulations of the San Joaquin Local Health District. �,L-Jath Com' �i�ht (Signed) --sE-F'T-1C---'f-ANK--SERVICE-------- -- (Owner and/or Contractor) By ------2915 E. Miner Ave., - Hp_6-3841 -------------------------------------------------------------- {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 ---- et-<._'--------------------------------------------------------------------- DATE----------- '.G_. . REVIEWEDBY----------------- ----------- --- ------- ------------------------------------------------------- ------------------------ DATE--------------- ----- BUILDINGPERMIT ISSU- ------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------- Alterations and/or recommendations:----------- ----- ---------- ------------------------------------------- --------------------------------------- ----------------- ------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------- - -------------- --------------------------------------------------------------------------------------------------- ------------------------ -------------T---- ------- ------------------------- I------------------- --------------------- -------------------------------- FINAL INSPECTI BY:. _... _.-- :_ _ Date--------.--------------------- t JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California F.P.CC.