21839 - Laserfiche WebLink

Home Browse Search

I FOROFFICE USE: w :-�---_-_. APPLICATION FOR ,SANITATION PERMIT Permit No. 11" . - . 7..--. ,. - - - -- _. , Complete in� 4icate) - -- -------- I - _.�� Date Issued ...1�_ :. 7 -� This Permit Ex ireiij'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. + 'JOB ADDRESS LO ATION----- -.---CL .%fit[. ----------------------------------------------------- - IiOwner's Name--AND ------------- �Y► r f---------------------------•----------- ------ Phone _-__�------------- ---------'----------------------------------------------------------------------------- + t.:,( ' iContrector's" Name__ -------------------------- • ----- --- ------- Phone--- linstallation will serve: Residence 6 Apartment House f] Commercial ❑ Trailer Court ❑ Motel ❑ Other,,❑ ! Number ofilivin9 units: __ �.__. Number of bedrooms __ __._ Number of baths-------- Lot size ------------------------------------. :Wafer Supply: Public system Community system ❑ Private ❑ Depth to Water Table �t-p_ ft. I�Character of soil to a depth of 3 feet: Sand I] Gravel ❑ Sa dy Loam ❑ Clay Loam❑ Clay ❑ Adobe Adand ` pae'❑ Previous Application Made: (If yes,dote ._-__-__. ) No New Construction; Yes [j No FHA/VA: Yes ❑ No ---- iTYPE OF INSTALLATION AND SPECIFICATIONS: !y (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t Septi Tank: +¢ Distance from nearest well------------------Distance from foundation__- Material___________ _J No. of compartments Size....................... Liquid depth-------------- --------Capacity--------------------- Dispo I PDistance from nearest well ___.------ Distance from foundation.--____-_-_-- - .._..Distance to nearest lot line__----________ y Number of lines------------------------------ ----Length of each line----- -------------------_--.Width of trench_-__--_____-_.--.------------: --- Type of filter material-------------------------Depth of filter material--------------- --I---_Total length------- -------------------- Seepa i . Distance to nearest welL�`6�J-------------Distance from f undation--AP..._._-'--__.Distance to nearest lot line_4' r, IJ d� Number of pits------:--�.----------Lining material-- r-k�--Size: DiameterDiamete'r,33- Depth- Cesspool: e th_r '/ 'i p ---------------------- Cesspool: o-:. . Distance from nearest well_________________Distance from foundation_-_._.-__.__�_...Lining material____._..__,______.._._.___.- -- �: ❑ !� Size: Diameter-.--- --�-- ------- --- �--------Depth---------------------------- - �- � ..,.�.�.. ..... .�,,...,� ------ ----Liquid Capacity- --------------------------gals. R Privy:( Distance from nearest well......... ......... f _________________________'Distance from nearest buildin :a 9 -------------------- ---------- ❑ Distance to nearest'lot line__ Ir -------------------------------------------------------r--------------------------- Remodeling ------------------------------ Remodeling and/or repairing (describe):__::�_..------t.--__---�- •--•. .�-.»« ' ------------ ---------------------------------------•---------------- ----- - ------------------------------------------ -------------------------------------------------•------------------------------------•----------------------------------------------------------------------------------------- ------------- ---- i ---------------------------------------------------------------------------------------------------------------------------------------------- -- -- ------------- --- --- - ------ -- - ----- - 1 hereby cert' y that I have prep, red this application and that the work will be done in accordance with San Joaquin County ordinances, Stat a , and rule an. 'regu flans of the San Joaquin Local Health District, Si neo � � _ ---------------_-----------------------_.---------------------.___.__.____-_____f--_______.__,........ t 6 BY=-------------------------•---------------------•--------------------- - -- -- - - caner an r Contract and/or or) ------ -------- (Title)----- --------------- - - (Pl ot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). PARTMENT USE ONLY- APPLICATION NLYAPPLICATION ACCEPTED BY______________ ___-.__-- DATE-- ^� --- ----- --------------------------------- ,. REVIEWED BY--------- -- ---------- - ----- -------------- DATE BUILDING PERMIT ISSUED-------------------- ---------------------- ------------------------------------•------------------ DATE----- Alterations and/or recommendations: F _ _ __ -----------------------------•__________._._ -------------------- ----------------------------- . -----------_---------------------------------------------------------- -.._________________________ i-------------------- -------------- � ---- -------------------- -----------------z-l-�---`-----�---- ------------------ T -W � FINALNSPECTION BY__ ______ _____ %.,\ -------- - ----------- Date-- ----------------------- .I IN LOCAL HEALTH DISTRICT F 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th street Stockton,California Lodi,California Manteca,California Tracy,California P F.P.0 q. ii V 6