22216 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ` ------------------} *-------- "" �. - /`' APPLICATION FOR SANITATION PERMIT Permit No. ............ _ (Complete in Duplicate) Date Issued " I This Permit Expires 1 Year from Date issued r Application is hgs-eby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This applit�ation is made in compliance with County Ordinance No. 549. 7 --- --------------------------------------------- JOB ADDRESS AND LOCATION.__1�-_a /----- ----- ------------------ --- Owner s Name ------------------------------------ .. -------- Phone--------------------•----------•---- Address--------t,_ 4w ------------------------------------------- -- Phone @@ "�.�Contractor's Name Installation will serve: Residence �rApartment House [I Commercial El Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/---- Number of bedrooms ___ Ir Z `�, Number of baths "-- Lot sizeS�--X ------------------------------ i Water Supply: Public system ❑ Community system ❑ Private �e-pth to Water Table�Y/" 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------........ No WIVew Construction: Yes &- o E] FHA/VA: Yes �o ❑ r TYPE OF INSTALLATION AND SPECIFICATIONS: ` (No septic tank or cesspool permitted if public sewer er is available within 280 feet.) � Septic Tank: Distance from nearest well___� Distance from founda--t-ion_ --`.---�-�,M�aterial. ` , ------ No. of compartments..42--------- ---- --Siz ------9..::Liquid -. _ - - -- _Capaci#y Disposal Field: Distance from nearest weil__V------.Distance from found at nz� �-""_----.Distance to nearest lot Length of each line._ 1,� -------- ----Width of trench----------------------------- L�' Number of lines.__ _____..yr._" --.-�j� 9 '-V-- Type of filter mate � l/C�/-Depth of filter material_Xx-- -- 10 Total length_ "-------------------- ��.._". Distance to nearest to li/ne.____._.__------- Seepage Pit: DiJance to nearest well__140Q..___Distance fr fours ation__ p � Numl er`.of pits----/_----------___Lining material" Size: Diameter_• __- .�--..____De t' Cesspool: Distance fio'n'.nearest well__.___----------Distance from foundation.............___._.Lining-material.__.____.-___.._..__.__._____________. ❑ Size: Diameter.'.----- ------- ---------- -- Depth -------- --------------Liquid Capacity----------------------------gals. IDistance from nearest building----- ---------------------------------- Privy: Distance from.earest well___."____----�--------------------- to nearest lot line----a_.__--- --- ❑ - ----------------------------------- Distance - ---------------------------------------------- 19- -------- I """"" i--- Remodeling and/or repairidescriLe): �. f ;I - - - - ---------------------------- --------- - --------- -----------------------------------------------II t ----•------------------------------------------ ------------------ ------------------------------------ ---------------'----------�---------------------------------------------------•---------------------------------------------- ---------- I hereby certify that I have prepared this applicatiov" bd49-th-e work will be done in accordance Iwith San Joaquin County ordinances, State laws, and rules,and regulations of the San Joaquin Local Health District. a z t # r Contractor} • .'- d . _ ..,..� f (Title)- do By -------------------------- o (Plot plan, showing size of lot, location of sys in relation to wells, buildings, etc., can be aced on reverse side]. k � t 1 r FOR-DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- + DATE' 7---------------------------- -- ---- �- S ---- ._ �_ ! DATE------------•- ---•------ -- ------------------ ---------- REVIEWED BY -- a BUILDING PERMIT ISSUED------- -----------------•-- f ' ----t--------------- DATE------ ---------------------------- ------------------------ _ ; ) A erati s and/or recommendations:_ ----------- ----- ---------- ---------------------------- ---•---------------- `-------------------------- { .. /1 ° - ( { L #i----------- -------------------------------------------°Y - '= w. -.-.-.,-.- ----- ---------------------- ------------------- ----- -------------------- ------------- -------------------------- ---- ------ ----------------- --------------------------- _________ _ --_-."__ __________________________________--- -------------------------- Date--------- _ -Date--------- FINAL INSPECTION BY:----- --...�3- ------ - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 P.Koielton Ave. 300 West Oak Street ii i t 124 Syiarnore Street 1 ZOS West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California