21623 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: r ------ ---- APPLICATION FOR SANITATION PERMIT Permit No. ....................... ---------- ------------ -------- -------------------- (Complete in Duplicate)P Date Issued _J--------_ -'- --- 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. JOB ADDRESS AND LOCATION---- �.,. re S4a--- -"- �---------------------------------- Owner's Name---,iF107_,r1_A/Q---- L9.0 !_f- --- ---------- ---------- Phone Address-----i------------------- -•---$��.?.----------------------•---- ----------- ----- c�` p��/._.. Contractors Name_ a---- Al' .1��. -- - �-- lei Phone__"X`' -.•�.4F J'� Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ' Number of living units: ..r_. Number of bedroom _ - Number of baths ../-__ Lot size .- --------------- Water -.--___-.. Water Supply: Public system W-l"C'ommunity system ❑ Private ❑ Depth to Water Table t. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe lardpan ❑ ` A Previous Application Made: (If yes,date-_- ) No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ t PE ►. TYPE OF INSTALLATION AND SPECIFICATIONS: J (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 5e tic Distance from nearest well-----------------Distance from foundation-------------------.Material----------------------------------------.----.--- I nq No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity-- ----------------------- # Dispos Distance from near st well.ilp. J- ...Distance from foundation.-./. -..----Distance to nearest lot line---- I .-. fpj Number of lines.... ...... ....... ....... .Length of each line.---. - O.-(.... ...Width of trench---�j �tAdType of filter material_. Depth of filter material._-.��........Total length---------------------------- ---Ab . if Seepa a Pit: Distance fo nearest well- Distance from foundation_-1.�_'0.-...Distanc� o nearest lot lin e._- Number of its.... ..Linin material._. Q -_--Size: Diameter._- ---_-. p- �-------------- g � �- �-- -- Dept Cesspool: Distance from nearest well--------__..---Distance from foundation------------------_Lining material.........----------------------------- E❑ Size: Diameter-_-.----------- ------ ----------Depth-- ------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well_------------------------------------------------Distance from nearest building._..........----------.-..--.--..-.------. ❑ Distance to nearest lot line-----------------------------------------------------------------------•------------------------------------------------------------------- a 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 County ordinances, Sta laws, and rules and regulations of the San Joaquin Local Health District. I (Signed)-- -46- �r--- oe 1� 2ye- .... ----------------------------------------- Contractor) I By: -----------(Title) ( -------------------------------------------- --- -----=-- - -r- UW(Plot plan, showing size of lot, location of system in rel on to wefts, s, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY r� APPLICATION ACCEPTED BY... DATE- �` - -. ---------------- REVIEWEDBY----- --------------------------------------- ----------- - ------------ ----- -------------------------- DATE----------------------------------------------------------- I BUILDING PERMIT I ISSUED------------------- -------------------------- -- ---------- DATE Alterations and/or recommen Mons: ----- -- - ---« .-. --- - --- - ------------------------------------ -------------- _ � ----------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------- ------------------------------------------------- ----- -------------- ----------------------------------------------------- � 7FINAL INSPECTION BY:... . -- - -------------------- Date---------------- ------------- ------ ------------------------ I SAN JOAQUIN LOCAL HEALTH DISTRICT 1801 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO. 1 �