21888 - Laserfiche WebLink

Home Browse Search

FOROFFICE USE: ------------------_---------- ---- __----------------- ---------------------- -- --------------- APPLICATION FOR SANITATION PERMIT Permit No. .21 -11- ----------------------- t__l_- ------------------------ ---------------------- ---------- (Complete in Duplicate) ----------------- This Permit Expires 1 Year From Date Issued Date Issued-5713-117 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. JOB ADDRESS ANDP C7E 7 / CATION_____Wr P '— p. Owner's Name---- _ ; :.:�: ,I �� { ... Y_ oneQ - 4 Ph Address---------..�L _s - Q - --•--- 7 Q x •--------- Z. ---------------------- Contractor's Name__ ' } pp /y -- - ' Phone_9!5(7 _6 Installation will serve: Residence Apartment Housek ❑ Commercial ❑ Trailer Court ❑ Motel Q Other ❑ ,fl Number of living units: I___- Number of bedrooms I--- Number of baths 7--Lot size Water Supply: Public system ❑ Community system ❑ Private DQ Depth to Wpfer Table Character of soil to a depth of 3 feet: I Sand ❑ Gravel ❑ Sandy Loam ❑ Clays�oam')Q Clay ❑ Adobe❑ Hardpan ❑ rn Previous Application Made: (If yes,date ---__---__---------) No X, New Consfruction:lYe-s [] No FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: {No septic tank or cesspool permitted if public sewer is available within 200 f'}.} --- 14 ' r'% F Septic Tank: Distance from nearest well_____-___.Distance from foundation___________________Material__.._____________.____-___________�_ El r --- ------_--Liquid depth------------247!,--------Capacity-----------=---------- No. of compartments______________�_:__-___:Size_____._________.__ _ Disposal Field: Distance from nearest well--------+--------Distance from foundation-__.�____________ Distance to nearest lot line.._____________ ❑ Type of fil er material_____________ Length of each line --------- I- I Width of,_trench------------------------------------ Depth of filter material______ _______'_____Total length_______._-_________-_________ ----------- il� Seepage Pit: Distance to nearestiiell__tQ_[2�---Distance frto fiundation_1_dQ-- _. Distance nearest lot lin -----. !! ' , - r Number of pits_...___t_ _---.______Lining materla3____J_ �-------.Size: Dia eter____✓t_. - epth__-�_�1�_ X, ------ J Cesspool: Distance from nearest well----------------!Distance from foundation---_1 ...-F------Lining 'material--------------------------____ ❑ Size: Diameter---------------------- ----------- Depth----------------------------- -------k # ---'----Liquid Capacity---------- ---------------gals. Privy: Distance from nearest well _____.__..____I-------------------------------Distance Vfrom nearest building___________.__________ ------------------ ❑ Distance to nearest lot line_______-.._- A Remodeling and/or repairing (describe):______. " .�i-.... yj ---•----------------1 - j ---,------------------------------------------------- ------------ ___-----------------r_-------------1_ _ S -------------------- ------------------------------------------------------------•-----------4----•-----------------------•------------•----------•----- ---------------------------------------•--•------------- ---------------------------------- t -----•- I--------•-----•----------------------------------------------------------------------•------------------------------------- -- I hereby certify that I have prep ra ed this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) '' - --CS---------- -------------- -----------{Owner and/or Contractor) .� gY:---- - ----- -�ilo7ron (Title) - - - -- --------- --- P of plan, showing size of lot, of system in relation to wells, buildings, etc., can be placed on everse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----'T-1.-=-a----- ---------------------- --------------------------------- - DATE---- �� REVIEWEDBY--•-----•-------------------------------------------•------------------------------------------------------------------------- DATE-- - ----------------------------- ------------- BUILDING PERMIT ISSUED----------------------------------------------------------------------------------- ----------------- DATE-------------------- Alterations and/or recommendations:------ ---------------------------------------------------------------------- -------------------------------------------------------------------------- -----------•-------------------------------------------------------------- -------- ----------------- ------------------------------------- -/-------------------------------------------------------------------I--------------------- FINAL INSPECTION BY: ��J------ --- - --- Date-- ---------- ��' SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Nmelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockfon,California Lodi,California Manteca,California Tracy,California ES 9 REVISED S'-S9 3M 3-'63 F.A.CD.