21877 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: 2--- - - ----------- 9 7 /-__ ------ APPLICATION FOR SANITATION PERMIT Permit No. .a-�.y-7/� ---------------------------------------------- - --- --- (Complete in Duplicate) --- This Permit Expires 1 Year From Date Issued Date Issued C 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---/�__--'j� .�Q�_ Owner's Name------ �_.. ---- ---- ------------ 1/L � ------------ Phone------------------------------------ Address---------------- Q� ------- --- Contractor's Name-C �� \ - ------- ''�9------------------------------------------# Phone./Zlgi -_7`/ Installation will serve: Residence pertmen ouse ❑ Commercial ❑ Trailer Court ❑ Motel ❑'Other ❑ Number of living units: I...... Number of bedrooms _';._.Number of baths 1____ Lot size ___ ______________ _________________--_-__-__r L Water Supply: Public system ❑ Community system ❑ Private epth to Water Table &-ft. !' Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobelardpan Previous Application Made: (If yes,date------------ - -- - I No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No [, HN TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) £ � ----------M�rial- S- epi La Septic Tank: Distance from nearest weII�Q.Q-_-----Distance from foundation__,lQ o� (p No. of com pa-rtrnents�- ------------------ e f q P r)-----------Capacity---�4 I � �j� Size-�� y,�-- _Li uid de th____-_-- - Dispos I Field: Distance from nearest welC:`--_ _ __- -.Distance from foundation.__�a__._ _Distance to nearest lot line_______ -Q. Number of lines-__._�y--- I-----k.__--- -._._Length of each line _f__j.- _------_.Width of trench_____,.`----_.-___-_ Type of filter material S_" Depth of filter material__-._--4 ---------Total length-------------------11 Z .`---_---_- 4 vi:C� Seepage Pit: Distance to nearest well-.-�(�f_- _..__Distance from foundation------� Q-_:_.Distance to nearest lot line-- __-- '`��'(� Dumber of pits.-_J__�-------------Lining:material- t2 , . - _-.Depth-_ __---------------- Cesspool: _ � Size: Diameter_-- _� _ r _---------- Cesspool: Distance from nearest well-----------------Distance fro oundation---------------------Lining material......._--.... ____-__----_-----. ❑ Size: Diameter--------------------- ------ --..-.--.Depth----------------------------------------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest we] ---------__`---------------------------------Distance from nearest building________-----_---__--_-_------------- ;. � ` --- ❑ Distance to nearest lot line-------------------------------------------------------- Remodeling and/or repairing (describe I--------# ------------------------------------------------------------------------- 4 ---------------------------------------- -------- n-------- ------------------ -A� -------- --------------------------------------------------- ----------------------- ---------------------------'-------------------------- -------------=------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I'have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, an rules and regulations of the San Joaquin Local Health District. q� � (Signed)---------------2av- ---�r---. io4l----------" {---- -- -- -- ----- ------------------------------------- - -- w . r Contractor( SEPTIC TANK SERVICE ------ - --------------(Title)------ --- -- - --- --------------------------------- ----- - (Plot plan, showing size of lot, location of system in r tion to wells, b ings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---------------------------------------------------- DATE------ - REVIEWEDBY--------------------------------------------- -------------------- - -------- - ---- ------ -- ------------------------------ DATE----------------------------- BUILDINGPERMIT ISSUED------------------------------- --------- ---------- ----------------------------------------------- DATE----------------------------------------------------------- Alterations and/or recommendations:_----__--_____------- ___--_____ -------------- �. r I --- ------------- -------- -------------------- ------- =� ------+----- I/---- ---- alar �`- --------- -=y-- ---- �/ (,rJ l' - �' ------------------------------------------------ ------------------ ------------------------- ---- - ----- ------------------------------------------------ ------- l ---------------------------------------------•--------•------- -------------------------------------------------------------------------------------------------------- - ---------------------------------------------- 4JA FINAL INSPECTION BY---------------- v Date-S N IN LOCAL HEALTH DISTRICT d� f 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.Ca.