20550 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: -------------------------------------------------------- __________________________________________.._____-_ APPLICATION FOR SANITATION PERMIT Permit No. ------- ------------------------------------ ------------ (Complete in Duplicate) - -- ------- -------------- --- This Permit Expires 1 Year From Date Issued Date Issued O__---12L.-7:4W Application is hereby made to the San Joaquin Local Health District for a permit to construct and instalewo'rk herein ascribed. This application is made in compliance with County Ordinance Na. 549. ]�3 � I JOS ADDRESS AND LOCATIONS 0y ,Q� ,C -- r�;l Owner's Name____ -�- Address--------- • -- ------- - -rr ------•--Tc�y ContractorysName------------- -------/ J—r�------------------------------------------------------------------------ Phone---------------------------- - Installation will serve: Residence Rr",�partment House ❑ Commercial p Trailer Court ❑ Motel ❑ Other ❑ t Number of living units: _-___ Number of bedrooms _a._ Number of baths _Z__ 'Lot size _x_�-I------------------------- Water Supply:pp y: Publicsystem ❑ Community system ❑ _ Private.[�tiepth to Water Table 26114. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ 'Sandy Loam ❑ Clay Loam Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date.__.._`_____________f No Er--,New Construction: Yes ®,"No ❑ FHA/VA: Yes ❑ No K�_ TYPE OF INSTALLATION AND SPECIFICATIONS: f k j+ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T nk: Distance from nearest well__15o29-- Distance ffpm foundaticn_Z49---_-_-_Mater No. of compartments-__ fA.. ___.--_-_...-_-Size_ /7 tJr_.�.�--- -f.�------Liquid depth----��-�--------Capacity--�_f__�t�-- Disposal Field: Distance from nearest well....��_-.._Distance from foundation__ - ___.Distance to nearest lot line-------------- RK-1 ________________ [ � Number of lines_________ _____f__ ___-- ength of each line___1:00--_____-� _ Width of trench_.rZ` ---_-______-----.____ Type of filter material__`-- �f�epth of filter material_____ --- _Total length....... .w _. yam, ` / ,_ .. . Seepage Pit: Distance to nearest well-_- ��/�--_---Distance from fou dation___f�_____-Distance to nearest lot line_________________ Number of pits._.._.------------Lining maferial__1467Z/-___Size; Diameter_./y--'-- r Cesspool: Distance from nearest well______ Distance;from foundation------------------_Lining material-------- ---- -------------------__ r_. - ❑ Size: Diameter__-- _____-__ 3Depth r 1 ------- --------------Liquid Capacity,- ---- -----------gals. Privy: Distance from nearest well___ ---------- --------Distance from nearest building ❑ Distance to nearest lot line---------I--_ ----- Remodeling and/or repairing (describe)--------------- ------- --_-- ------ t ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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 and regulations of the San Joaquin Local Health District, - 'if (Signed)------------------------ ( std�or Contractor) -- -- --- By:. -------------------jinrela (Title) • i £. ------ ----------- (Plot plan, showing size of lot, location of syste ' o eell,�, buildings, etc., can be placed on reverse side). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ----------- -------------- ------------------------------------------------------- DATEw ) REVIEWEDBY--------------------------------------------- •--------------------------- -------------------------------------------------- DATE `------ BUILDINGPERMIT ISSUED------------------ ------------------------------------------------------------------------- --------- DATE.------------------------ ------------------- ---- Alterations and/or recommendations:-----------------------------------------------------------------------•------------_- ! -------------- --------------------•------------------ ----------------------------------- --- i ------------------------ -------------------------------- ----- - } --------•------------------------------ --------------------- ------------------------ ---------- ----- --- . FINAL INSPECTION BY.-..__ ------_,__ - ---------- --- Date------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street !� Stockton,California Lodi,California s Manteca,California Tracy,California a ----------- . -