21935 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ---------------------------------------- - -------------------------------------- + m i APPLICATION FOR SANITATION PERMIT. Permit No. .•.............•.__.... ------------------------------------ --------------------------------- V. (Complete in Duplicate) pate Issued �l_I_. -- � -.._-----_.___- --_----_-------_--__-____--___- ___ This Permit Ex fres 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install thq work herein described. This application is,made in compliance with County Ordinance No. 549. c ` 2"717 r.�cFi.Ih- JOB ADDRESS AND LOCATION � -9p f Owner's Name �'�� ------ l ` F �� ' /-- ------ - ----------1=--------------------------- Phone._��e Address,..-- -- Contractor's Name--_-- __-- . -•- - Phone..---- - -• wT✓� - ---- --------- ------------------------ - -------- Installation will serve: Residence ©--`X`partment House ❑ Commercial ❑ Trailer Court ❑ (Motel E] Other Number of living units: _. __ Number of bedrooms _-3._ Number of baths .f--_ Lot size --._�r___�J_-------1__:----------�J__________________ Water Supply: Public system ❑ Community system ❑ Private M-�epth to Water Table f�? ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑�_ Previous Application Made: {1f yes,date---- _--- ------I No ❑ New Construction: Yes ❑ No �A/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) IVA, is an k... Distance from nearest well-----------------Distance from foundation-------------------Material-------------------------------_-----__________. N N J ,, No. of compartments--------------------------Size--------- ----------------------Liquid depth--------------- Capacity-•-------------------- J as fold: Distance from nearest well-----------------Distance from foundation____________________ Distance to nearest lot line--------------- Number of lines------ ---------------------------Length of each line--------------------------_._-Width / ' - - 4of trench------------------------------__--- �} "`"*nType of filter material-------------------------Depth of filter,material____--`___--__---_Total length------------------------------------------ . :,. _ _ - Seepage Pit: "°rDistance to nearest well�f�- _.______Distance' from foundation-__._ ___.Distance to nearest lot line--__ �h [ Number of pits......r------------Lining material- Size: Diameter_ -._.___Depth_....7.�-r.______ .-__#; , Cesspool: Distance from nearest well-----------------Distance from foundation....................Lining material_._..___...-__.._ ❑ Size: Diameter-----r--------------------------------Depth-------------------------------------------------._Liquid Capacity-- --------_----------------gals. Priv Distance from nearest well._____-_____.___._ ________________Distance from nearest building Y' +,. g ------------------------------- [{" Distance to nearest lot line. -- - . Remodeling,and/or repairing (describe: =--------------- ---- ---- ----------------------------------------------- 4 ------------------------------------------------------------------------------------------------•--------------- ------------------------------------------------I ---------------------------------- ------------------------•------------------------------------------------------------------------------------------------------------------------------------------------ ------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances,dS1 Lelaws, and rules and regul ions of the:San Joa uin Local Health District. Si ned � «rf., .., �- --C,�-___________________ __ O ner and or Contractor( 9 �------ 0.- -- -------- -- --------Title --- - --- - { - -- ----- /- ' [Plot Ian, showing size of lot, location of system e p g y relation to werlls, buildings, etc., can 6e p aced on reverse side). fi e. + FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- --------- ---------------------------------------- DATE-------- �--------- REVIEWEDBY---------------------------------------------------------------+------------------------------------------------------•--- DATE-------- --`---------------------------------------------- BUILDING PERMIT ISSUED----------------------------- ----- -- DATE------------ - y-------------------------------------•-------- Alterations and/or recommendations__ _ _____ -- fjo ------------------------------------------------------------ --- ------ ------- --------•---- ------------------------------------------------------------------------------------- ----------•------- ------- ------------------------------------ --------- --------------------------------------------------------------------------------------------------------------------- ------------------------------- --------------------- ----- ------------------- ------- - ---- - --- ------- --------------- ---•---- ------------------------------------------------------------------------ -------------------- ------------------------------------ - ---- f , FINAL INSPECTION BY: -. - Date ............---------------------- ------ -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California A F.P.CO. i