21031 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: I 0 ------------- APPLICATION FOR SANITATION PERMIT Permit No. .s`�_� 1 (Complete in Duplicate) ¢ This Permit Expires 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 thew rk herein seri ed. This application is made in compliance with County Ordinance No. 549. �� JOB ADDRESS AND LOCATION r �-- 7rf 5--4_�- LIJ� � Owner's Name...tle`1l .P17--•---- -a.,K 4 ------------------- - --- ------ ------------------"---------- - - Phone... ------------------------------- Addressf ":'?----- lL � i'? --------------------------------------------------------------- r Contractor's Name / 1 �-% - ��ir? � '' ---------------------- -------------------------------------- - --- .. Phone------ --------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court �] Motel ❑ Other ❑ Number of living units: J___ Number of bedrooms -I-_ Number of baths _ c... �o size l __-_.-._-_------.-_._ Water Supply: Public system ❑ Community system 0_1�private ❑ Depth to Water Table :--- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date-------------- -_ } No [ New Construction: Yes P`No ❑ FHA/VA: Yes �!r No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ` (No septic +ank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_______-- ~....Distance from foundation.--le>_----. Material-//eC�°�t=`rl_l- .______ .--._. /_ No. of compartments----A____________ _ __Size�//J ___-Liquid depth- 15.". ________Capacity_/Zl-il�---- Disposal Field: Distance from nearest well -_- -----Distance from foundatign---�f� -Distance to nearest lot line_'--1.____. J ( Number of lines____ r Length of each line__ _ Width of french_--_-----_-.---_.._.___. Type of filter materia �/ D T ' 1�/ �'E --.--- epth of filter material-- -- f - _-.Total lengfh-,l�_�__...------_-------------- Seepage Pit: Distance fo nearest well.____—--------Distance fr m Distance to nearest of Number of pifs--_rte-------------Lining material_ � Size: Diameter DepthAX_ _- Cesspool: Distance f;-cm nearest well...-- .--Distance from foundation -- ------------ Lining material..----------------------____- ❑ Size: Diameter--- - - ---- - - - - -------------- Depth----- --- ------------------- - - - - -- - - Liquid Capacity- ...-------------- -gals. tp Privy: Distance from nearest well................ Distance from nearest building___,-..---------------. ❑ Distance to nearest lot line-.... .. __-_ 0 -Remodeling and/or re airin9 {describe :__ -- -- --------------------------------------------- - - - ---------------------------------------------------- ------ - -- - ---------------- ----" ---- ----------- - ------ Ihereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)------------------ .-- _ {owner-ten+ or Contractor) Title By: 1 - '-------- ------------------- --- -i )-&-✓i7t�[- (Plot plan, showing size of lot, location of sy em in relation to wells, buildings, etc., can be placed on reverse side}. to FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY... - -A V`7r--- -------------------------------- ---- DATE_..-- REVIEWED BY ------------------ -- ------------------------ DATE.._-.--- BUILDING PERMIT ISSUED------------- --------- --------------------------- -------------------- DATE---- -----"---------- -- - --` Alterations and/or recommendafions:------- l� _:t-= - '` sem` c=-:{ _-- ........ �.z "L(� `.:_>� .�..: sr -. - - ( '� ----- -- -------------------------- ------ FINAL INSPECTION BY:.---- ... _--. Date SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haielton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton, California Lodi, California Manteca,California Tracy, California F.a.co.