21112 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: --------- ----------------------------------------------------------- - -""" - -"-- -" ----------------- -- APPLICATION FOR SANITATION PERMIT Permit No. -2_.,1z1 ------------------------------ ----------------- ----------------- (complete in Duplicate) Date Issued ' This Permit Expires 1 Year From Date Issued - ----- ------------ -------- -------- ------ --------- g Application is hereby made.to the San Joaquin Local Health District for a permit to construct and install the Ser herein This application is made in compliance with County Ordinance No. 549. t{/71j JOB ADDRESS A OCATI N .�J�rcl.`----- ----------- Owner's Name---------- -W---------- - - - ---- ------------------ --------- - - Phone------------- T - -�--------------- --------------- --------------------------------------------- -------------- ------•-•----------- Address_... 1 ,. _. Ph Contractor's Name__._-._ -- ------- - Installation will serve: Residence [Apartment House ❑ Commercial ❑� Trailer Court ❑ Motel [3 Other ❑ t f Number o baths Lot size ��'� `'r ------------------------------- Number of living units: {--.--- Number of bedrooms __ Water Supply: Public system ❑ Community system Privy}e Depth to Water Table -------- ft. 11 Character of soil to a depth of 3 feet: Sand F-1 Gravel F-1 Sandy Loam Ll Clay Loam El ❑ Adobe[D Hardpan Previous Application Made: (If yes date_..-_..__.- "-) No ❑ New Construction: Yes ❑ No E] FHA/VA: Yes [I No TYPE OF INSTALLATION AND SPECIFICATIONS: -- _�- „•{No septic tankoor_cesspool_permitted-if-public-sewer is-available-within 200-feet:j'"--� � —� Septic nk: Distance from nearest well `5-------Distance from fo undatisn__.l! _____.__Materia___.._ ' ` '--'------- No. of compartments__?-� --------------Size-. --- -- - _Liquid depth ------ - - - ----------Ca{�auty-- - - - -- Dispos Field: Distance from nearest well.--__-_____`.--Distance from foundation--._�_ "�"_._.Distance to nearest lot line_ f�" -_-- �� ' . . Number of lines--:--------- '------- --------Length of each line--------la0- -------Width of trench_`�--------".------------------ I I Type of filter material.____.S-° �_-„---Depth of filter material____./f-i.____”"Total length__.__.P-ao------------- ------- i PO_�"-----Distance from foundation_1.a.."____.....Distance to nearest lot line_S-"_-._---._ Seepa Pit: Distance to nearest well___.__f____" Number of pits.:------- ------Lining material_._S_f __----Size: Diameter._,L ---------Depth--- S- ------------------ j Cesspool: Distance from nearest well-"---------------Distance,from`foundation --- ----------------L:ining material--. f ❑ = F I material-".--__".._.--..--__. .__._..-.-___- uid Capacity - gals. v----------------- ----------------------Liq Size: Diameter--, Depth Distane from nearest' building------------------------- PrivY Distance from nearest well-------:____-"--_...____._ " . jI r ❑ Distance to nearest lot line______________________ ---------------- ------------------------------- __"---...-.---.------ 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 aunty ordinances, State laws, a ru sand regulatV+The Joaquin Local Health District. ({prWTr@r�and/or Contractor{ { g -- ------_- By-•_----- ::,�„-- --------- ---:"------ -- _ k' Y{Pion pplan, showing size of lot, lova}ion of system In relation f wells, buildings, etc., can be placed on reverse side). t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.! ! ----------------------------------- ------------------- DATE--- _.�.� - - ------------------- ?_-� REVIEWED BY DATE---------------------------------------------------•- I BUILDING PERMIT ISSUED---------------------------------- ---------------- DATE : r ------------------- - ----------•--------- Alterations and/or recommen a tons:_________________________________.-__.-__.__" - •------------------------------- ------------------------- ---------------------------------------- --------------- -.-------------- ------ -------- ------- --- --- - - --------------- --------- - -----------•------------- ---------------------------------- ------------------ ---------------------------- ------- -- -------- - --------- ----- ---- FINAL INSPECTION BY/. _ - /rt�� Date �'" T X' SAN JOAQUIN LOCAL HEALTH DISTRICT F 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street � Stockton,California . Lodi,California Manteca,California Tracy,California