21436 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ------------=----------------------------------= -------------------------------------------------------- APPLICATION FOR SANIIATION PERMIT Permit No. - -------------- ----------------------- (Complete in Duplicate) / Date Issued -.�!/rte s -------------------------------------------------__._.- This Permit Expires 1 Year From Date Issued /F�.. 7_11 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 AND LOCATION-/= � --------- ------------- -- - -------------------------.................---.......... Owner's Name---- ' 4. 1 -`- +.c? Phone------------------------------------ ---------------- - Address-----------/-„�"'•--Z90--------t ----- �sg..d �1 ------------•-- i f Contractor's -------_- ' - Phone----------------------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Courtpv Motel ❑ Other ❑ Number of living units: --:.---- Number of bedrooms -------- Number of baths -------- Lot size -------7-. .__._Y-. j.7------------------------- Water Supply: Public system '2j Community system ❑ Private F Depth to Water Table (A0__ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam] Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: llf yes,date-----.--------......) No ❑ New Construction: Yes ❑ No ❑ FHANA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: I , . t (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 ----- ----Disposal Field: Distance from nearest well_ Distance from foundation--J.0"+-.--.Distance to nearest lot IineY-0' -------- Number of lines--------)--------------------------Length of each line--1 -------------------Width of trench-�-`---------------.------ Type of filter material__ �Xk---------------Depth of filter material--- ,t-pf -------Total length__�__y.-__---_---------------------.-. Seepage Pit: Distance to nearest well-----------_----___---Distance from foundation-------------------.Distance to nearest lot line----------------- El Number of pits-----------------------Lining material------------------------Size: Diameter-----------------------Depth--------------------------------- Q Cesspool: Distance'from nearest well-----------------Distance from foundation--------------.____.Lining material--------.----.---. ---------- 01. Size: Diameter--------------------------------------Depth----- -------------------------------- -------------Liquid Capacity----------------------------gals. Privy:'' Distance from nearest well-------------------------------......._---------Distance from nearest building-----------------------------------------. Distance -to nearest lot line----------------------------- -------,---------:-------------•--•---- --------------------------------------------------- ---------------- r Remodeling and/or repairing (describe):---------------------- ---------- ------------- --------------------------------------------------- -------------------------------------------------- ------------------------------------------------ -------•-------•------------------------ -------------------------------------------------------------- ------- --- ---------- -- ---- - - --- -- 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, and rules ca�nld regulations of the San Joaquin Local Health District. (Signed)-------- --------f L`�-_.t, ---- ----------- ------------- -------------------- --------- --------------------------(Owner and/or Contractor) `-By:---------------------------- ---------------, ----------------- ------------------------------------------------------ - -----(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 '`• ----------------I---------------------------------------- DATE-_-/9-'_ .7 ------- - REVIEWEDBY------------------------------------ --------------- - ---- ------------------------------------------------------------- ----- DATE--------------------------------------------------------- BUILDINGPERMIT ISSUED---------------------------b'0------ ----------------- -----•--------------------------------------f_DATE.---„---------------------------------------- ---------- Alterations and/or recommendations:--.._; ----� f''P%��.,r------------�'/7 Uzi-s"-��,� ' --,----. !7.,*r rct''+.... -,� T/1/ - r-1'-------:•. �'?`---'l'` !�-��---- �=-i/�-�t--'---� -• ------ -------------- '--- - ': _.7�t '�./f.a --- ------ w--rs-- --------------" -�--------------------------------------- --- - -------------------------- d f ------ ------------------------ ----------------------------- ------- ------------------ ----------------------I------------------------------------------------------------------------ ----------- ------------------------------------- ----- ------------------------------------------------- ------ FINAL INSPECTION BY;� ;�_._= ----- ------------------------ Dafie f l�3'f -------- ------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ho:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California . - , F.P.CC.