21844 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE'S - - -�-------- f _/ Lf�,� �- APPLICATION POR SANITATION PERMIT Permit.No. (Complete-in Duplicate) '- -- --------V_--..� -------------------- This Permit Ex ices 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the w k herein described. x This application is made in compliance with County Ordinance No. 549. .�f F '�Q ------ JOB ADDRESS AND LOCATION---- � --- - ---- -�---- Owner's Name .-----1.----- 4?- -- ..T- --------- --------------------------------------- Address ----------------S't/ ` ' �/ta1�"__. _.... • ---- Contractor's Name---- !"---- _.....------- .A-- 5� - �✓ ------------•---------- Phone-_4 Installation will serve: Residence % Apartment House ❑ Commercial: ❑ Trailer Court ❑ Motel ❑ Other [I i Number of living units: -1-.--- Number of bedrooms __?/- Number of baths]_ _ Lot size ----10-...xl_f pp..---------------------- Water Supply: Public system ){ Community system ❑ Private [� Depth to Water Table fiDQ ft Character of sail to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay X Adobe [j Hardpan [] Previous Application Made: {If yes,date-----------------__- } No* New Construction: Yes ❑ No P0 FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: !! Distance from nearest well-----------------Distance from foundation--.---.-.--.---_.-.Material---...-_-----.------------------------------------------- ❑jfVLc,'t'fNw No. of compartments---------- -- ------------Size--------------- ---- -----------Liquid depth--------- ------ --------Capacity----------- Disposal Field: Distance from nearest well----- -----Distance from foundation--------------------Distance to nearest lot line-----_-_------- ❑ dumber of lines.----------------------------------Length of each line---------------------------..Width of french.-.---.-----------.-.----.------.._ Type of filter material-------------------------Depth of filter material------ --- -------Total length--------.------------------------------- .- Seepage Pit: Distance to nearest well_,-A)VA1.E--_Distance rom undatiori__.,/iQ---.__.Distance to nearest lot line..------------- [� Number of pits_ _d,.__Lining material__ i ul. Size: DiameteAXA Dept h......../_Z----------------- Cesspool: .Z-_-------------- Cesspool: Disfance from nearest well ----------------Distance from foundation----------------: ..Lining material.-_.. -------------------------.-----. ❑ Size: Diameter- -- ------------- --- ........Dept h------ -- - - ------------------- ------- - - ---:-Liquid Capacity-------------- ------------gals. Privy: Distance from nearest well................................ _.--------------.Distance from nearest building_.-----...---_---_----__-----.-.----- i ❑ - Distance to nearest lot line -------------- Remodeling and/or repairing (describe):--.. Q------ ---•---------------------------------------------------- --- - --------- ------- -- ----------------------- --- --- - -- ----- ---- ---------------------------------------- -- I hereby certify that ve prepared this application and that the wo will be done in accordance with San Joaquin County ordinances, State laws, d les and regulatio of the Sart Joaquin Lo ealth District. - --- -- -- ---------- - --------- Contrac (Signed) _.-(Owner and/or tor) By--------------------------- "•(,�^-"� - {Title) - # - I (Plot plan, showing size o at, location of system in elation to wells, buildings, etc., can be plat on reverse side). FOR DEPARTMENT USE ONLY 1 APPLICATION ACCEPTED BY------ REVIEWEDBY------------------------- ---------------------- -----------_---------------- - --- -----• _-------------------------- DATE---- - --------------------•-------------------------------- BUILDINGPERMIT ISSUED-------- - ---_-------------- --- -----------------•---------------- --------------------- DATE-- ---------------------------------------------------------- Alterationsand/or recommendations:---------- -------------------------- --- --------------------------------------------- --•---------------- -•-------------------- ------------------ -------------- ------------ ----- - -------------------------- ------I.................. ---------- --------- ---- ---------- ---- ---------------------------- - - - ------------ --------- -- --------------- t FINAL INSPECTION BY:. --- --.-.- -- ----------------- Date- - ----------�--- - ------------------------------- SAN ---- ------ --------------SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E,Hazelton Ave. 300 West Oak Street 124 Sycamore Street 2Q5 West 9th Street Stockton,California Lodi. California Manteca,California Tracy,California E.K.9 2M 1.67 Vanguard Press 4