21202 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: - ------------- -------- ------ T APPLICATION FOR SANITATION PERMIT Permit Iyo. : ---------------- ---- -- ----------------------------- F; (Complete in Duplicate) Date Issued _ _ ------- 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. ` �t e JOB ADDRESS AND LOCATION..li- � (. ------ >J-iC7 ---•--- ----------------- _ Owner's Name------- -5 '-------1'i e!e 4`•------------------ ----- - ------------------------A--------------- - Phone----------------- ------------- Address ---•------- 1,� 1 Address.------- �`---�•-------.a"l c ....-R-----�J-'� r- � --------•------------------------------------------------------------- --------------------•----------- Contractor's Name--- /jecr- 4 .t'r-------------------------=------- --------------------------------------------------------- Phone---------------------------------- Installation will serve: Residence ['Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Oth7 ❑ s< Number of living units. _ --- Number of bedrooms%-?-- Number of baths -/___ Lot size -4077-x....2-1to----------- -.---- Water Supply: Public system Community system E] Private Depth to Water Table 40 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 9?'Hardpan ❑ Previous Application Made: (If yes,date--------------------) No ®'". New Construction: Yes PH- No .0 FHA/VA: Yes ❑ No P-- r TYPE OF INSTALLATION AND SPECIFICATIONS: "• (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I - F �p Septic Tank: R Distance from nearest well ------------Dista Ce from foundation--.t 0--.-.----.Mat r`a��'�'Cs_40 _------------------- No.'of compartments-- -. --------------Size y--.- '_ -a Liquid depth_ --.-.-.-_--_--Capacity- 2�i1A----__ \ Disposal Field: Distance from nearest well---_`"------.-Distance from foundation----Z2."____'Distance to nearest lot line-Ire V Number of lines------ - Length of each -------- ---Width of trench- -.-_--------- ------- -- F . Type of filter maters OL` -Depth of filter material--- `P. Q_Total length-.Z#m.r _-_'r_.------- . Seepage Pit, R Distance to nearest�ywell----f,-!------_------Distance from f undation-a?,G9..----_--.Zisfance to nearest lot line-4----__--._ �: i N tuber of pits.'ka4_-..-_____-Lining material- .--.Size: Diameter--> -------Depth ------------------- ------------ Distance from nearest well-----------------Distance from foundation-------------------.Lining material--.------.-_---.-.-----------_------" ` ❑ Size: Diameter---- ------------------ Depth-------------- ------------- ----------------------Liquid Capacity_--------------------------gals. kk _.Distance from nearest building i Privy: Distance from nearest well------------------------------------------------ g -----------------------.:----------- - ❑ Distance to nearest lot line. ------------ - !------ Remodeling and/or repairing (describe):.-------_, :1 f ------------------------------ ------------------------------------------------------------------------------------------•--------- ------------------------------ t ----------------------------------- -------------------------------------------------- ------- ------ ---- ------------------------------------------I-------------- ---------- ---------------------------------------------------------------------------------------------------------- ------------------------- 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 r les And regulations o the San Joaquin Local Health District. I 1 (Signed)--------------------- (� Contractor) B ---G ---------- -------(Title)----( �dl�/1£-------- ------ --- ------ - (Plot plan,.showing size of lot, location of system ' elation to wells, buildings, etc., can be placed on reverse side). i R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- -- - -- - - - ------ ----------------- ---------------------------------------- DATE------- ��------------- - ---------------- REVIEWEDBY------------------------- ------ - ---- -- - ------------------------------------------------------------------ --• DATE----------------------- ------------ ----------------------- BUILDING PERMIT ISSUED. ------------------------ --------- DATE. ----- Alterations and/or recommendations:---. -. �- ` 9' 3 -------��-- ---------------------------------------- ---- -=---------------------------- ----- ---------------------------------------- - - pfi -06------ 4 ------/0 ------ --------------------------------- --------------------------- ----------- ------------------------------------ FINAL INSPECTION BY:.---- ----f1- -------------------- Dat --. -- -- --- -=------ -------- ---------=--------------------- ' SAN JOAQUIN LOCAL HEALTH DIS , 1601 E.Horelton Ave. 300 West Oak Street 124 Sycamore Street 245 West 91h street Stockton, California Lodi, California " Manteca,California Tracy,California