21921 - Laserfiche WebLink

Home Browse Search

FPR OFFICE USE: � - ,. APPLICATION FOR SANITATION PERMIT Permit No. i ----------_ (Complete-in Duplicate) r r { This Permit Expires 1 Year From Date Issued Issued _______________ _______ - --------- ...-------- - Date Iss 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. JOBADDRESS _ _..- -------------------•-------------------------------------------------- Owner's ------Owner's Name----- - -- ----- ----- n - --- - - - - --- ---------------------------------- Phone. Address------ . ' ------------y------------------------=-5- -------------------------- Phone..----•-----------.----------Contractor's . i Installation will serve: Residence ] Apartment House [I Commercial ❑ Trailer Court ❑ Motel ❑ Other El Number of living units: Number of bedrooms __3____ Number of baths__._l__- Lot size ____ x__;Z�------------------------- Q' Water Supply: Public system Community system [] Private ❑ Depth to Water Table .fP._a_ _ ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ® Clay ❑ Adob!e ❑ Hardpan Previous Application Made: (If yes,date--.---------------- I No ® New Construction: Yes ❑ No N FHANA: Yes ❑ No DQ,/-) 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 fouunnci tion Liquid �'t___.Mas5rial -_-- - -Ca d 1... No. of compartments__. Z..............Size_ �11 q p. pacity---i0. e-_ Disposal Field: Distance from nearest weft-_" ......._Distance from foundation_-�a .__.__._.Distance to nearest lot line__._______.. Number of lines.__-__---_I... .................Length of each line__._--_.fdU°_____-_-..Width of trench___. _y_�'_------------------ F Type of filter material__-90- --_____Depth of filter material __lM----------Total length_____-�Ga_'------------------------ Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------.Distance to nearest lot line__.._-----._____ ❑ Number of pits--- ------------_-_---Lining material---------------------- Size: Diameter------------------.----Depth---------- ---------------------- Cesspool: Distance from nearest well ----------------Distance from foundation--- -------- ..Lining material-.-____----__.__-__--- ___--___._ ❑ Size: Diameter- ------------ ----------------Depth--------------------------- ------------Liquid Capacity----------------------------gals Privy: Distance from nearest well------------------ ------------------------------Distance from nearest building_-----_-:-______.__.__----____.__:::.. ❑ Distance to nearest lot line ------- ---------------------- ----------- ---------------------------- -------------------------------------------------------- ----------- �f�e��_. ------ ---- -- -------- Remodeling and/or repairing (describe):_-/l --• ------• --- - -------------------------------- - ---------= --------------------------- --------------------------- - ----_--------------------------------------------------------•-•----------------------------------------------------------------------------0---•------------- --- ----------- ------- ------------------------------ -- ---- ------------------------------------------------------------------------------------------------------------------------- --------------------' 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, and rules and regulations of the San Joaquin Local Health District. (Signed)-- - ` - .................. - (Owner and/or 'Contractor By:_e --- -------------------- ---------- --- ------ -- ------{Title{ -- ------- - - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse slde). O PARTMENT USE ONLY APPLICATION ACCEPTED BY-------•------ ------- ------ -------------------------------------- REVIEWED BY-------------------------------- - 77 -- ------ - ------------------------ DATE----------�- _�9 -- ------------ BUILDING PERMIT ISSUED---------- --------- TE -ft Alterations and/or recommendations:.___ _ 7��.p.r.. ._ _.� 4;?/_1%11/ .�-. - -a-_� ' ti - ,p _. t.,191w, - --- ----------- ---------------jlam �` e_ "r:r... _ f�f � tilt �'�' L_b. SGC /� � T V_6 ----------1"fad�.. _. ..... ,^'y ---------- ------------------------------- IV ---------------------------_ I /+ FINAL INSPECTION BY:........ . - - ----------- Date.......... _� --- ---- ------------------=------------- S N AQUIN LOCAL HEALTH DISTRICT 1601 E.Maselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi. California Manteca,California Tracy,California E.K.92M 1-67 Vanguard Press