21955 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: � w;� '�� ---------------- ---------------------------------- Permit No. : f7-�� APPLICATION FOR.�`SANITATION PERMIT ----------- ----------------- ---- ----------- ------ a• , .. ----------- ----------- ---------------- (Complete in,Duplicate) - ------ - Date'Issued --�r----- ��-' � ----------- This Permit.Ex Cres 1.Y `T;r=F.rom Date IssuedX28` �tFC)0—t� Application is hereby made to the San Joaquin 7 Local-Health District for`a,permit to construct and install the work herein escrbed. This application is made in compliance with County Ordinance No. 549. ' JOB ADDRESS AND LOCATION------ 1.� ------ --- � . ej Al Owner's Name----------- > dY -.---e�4ve-r-u------------------------_- ----------------- Address -------------- Pone r ss_ 11_ 1 ------ / l/Y Add e _._. --�---5-------- ---�/..-----�-- � - ° �R one Installation will serve: Residence A artmenf'f-[ouse ❑ Commercial Trailer oiler Court ❑, Motel ❑ Other ❑ Number of living units: _--1---- Number of bedrooms 2—Number of baths .1___ Lot'size __ fes- --- ------------------- Water Supply: Public system X Community s st m ❑ Private ❑ Depth to Water Table -------- Character of soil fo,a,A,.,clepth of 3 feet: Sa d ravel ❑ Sand Loam El Clay Loam ❑ Clay Eldobe❑ Hardpan El.. .. . Previous ApplicatioiiUclle: (If yes,date_------------------) No New Construction: Yes ❑ No FNA/VA: Yes ❑ No ' TYPE OF INSTALLATIONi4ND-SPECIFICA �� TIONS: ' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: : . Distance from nearest well___--------------Distance from foundation--------------.-----Material------------------------------- KR i ❑ No. of compartments- --------Size--------------------•-------=---Liquid de th---------------- --------Ca acit ---- Disposal Field: Distance from, nearest weii_________________Distance from foundation________-_._.._----Distance to nearest lot line-------- � r ❑ Number of lines---------------- `---------------Length of each line-----------------------------Width of trench.------------------------------ Type ----:---------------- TYPe of filter material-------------------------Depth of filter material----------- -------Total length------------------------------------------ Seepage from foundation____ Q.......Distance t nearest lot line-----6 __-_-._ 1 Seepage Pit: Distance to nearest well._._ _ _ �- Number of pits_--.-__t-------.---Lining material-_._y' Q' '-.--.Size: DiameterRY.... epth ---------------- Cesspool: Distance from nearest well------- -.-._Distance from foundation!---------------._Lining material_________________________ ______ ❑ Size: Diameter-- ---------------------------------Depth------------- ------------------ -- ----------------Liquid Capacity-- 9als. I Privy: Distance from nearest well-----------------------------------------------Distance from nearest building---.--------------------------.----------. ❑ Distance to nearest lot l line-------------- --------- -------------------- ----------------------------------------------------------------------- Remodeling and/or repairing (clescribe�:_.._ e - - I ------------------------------------------ ---•-- ------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County I, ordinances, 'State laws, and ules and regulations of the San Joaquin Local Health District. ' {Signed) -------�--- -- -_---- - ----- _--. _ --- -- (Owner and/or Contractor)_ _----- BY:--------------------------------------- Title -_ - ----- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ' ` 1.1- ,•-� ------- -------------------- DATE--------- _"`_I�.__.� ..------------------- 1 APPLICATION ACCEPTED BY_...---._- REVIEWEDBY-----------------'--------------------------- -------------------- --------------------------------------------------------- DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED-------------------- --------------- DATE-------- -------------------------------------------------- Alterations and/or recommendations:--- -------------------- ---------------------------------T-----------------:7;------------ ----------------- --------------- ------------------------•------------------------------•------------------ -----------------------------------------------•-- - - ----------s------------------- ----------- -- ------------------------------------------------ -----•---------- --------------------- ---------------- - ---------------------------- ------------------------ a -- -------------------------------- - r l �f� `, FINAL INSP ON BY- . l�------ 1. Date - - . SAN JOAQUIN LOCAL HEALTH DISTRICT + 124 Sycamore Street 205 West 9th Street 1601 E.Haselton Ave. 300 West Oak Street Y + Stockton,California Lodi,California Manteca, California Tracy,California F.P.C C.