21814 - Laserfiche WebLink

Home Browse Search

V-iv W,rUK Vrrll.t UJt: -� J - - ----------- 1_ 3vr 7 APPLICATION FOIA'- SANITATION PERMIT Permit No. .'r :.ff- ----------------------- --- Ca ) ------------------- ::� e ------------------ -------- ----- (Complete to Duplicate) Date Issued p � p This Permtt Ex fres 1 Year From Date Issued Application is hereby made to the San Joaquin Local Healfh 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 A LOCATI N_ - -------------- Owner's -` i --------------------------------------- Owner's Name- ----- - t t -------------•---------- •---------------••----------- ----- -- - - - ----- -- -- -- Phone Address - -- -----•--- ---- Contractor's Name_____,:_ ._--_ -- -__ -- ` ------------------------------------ ---------------__________________ ----------------------------------------------- Phone----•----------•- R E Installation will serve: Residence'�Apartment House ❑f, Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: -- Number of bedrooms -- Number of baths _/___ Lot size r - a ---------------------- Water Supply: Public system ❑ ,Community system ❑ Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feef: Sand ❑/Gr eI,0 Sandy Loam ❑ Clay Loam Clay r Y ❑ y ❑ Adobe Hardpan Cl "�7 Previous Application Made: (If yes,date 4__--- -..-_) No �w.New Construction: Yes ❑ No Fj'FHA/VA: Yes C] No -v TYPE OF INSTALLATION AND SPECIFICATIONS: *. ` (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Zan t Distance from nearest well-----------------Distance from foundation____________________Mafierial__.__________.._ .____....-______. -__ � y`; No. of compartments --- ---------------- ----------- Di Ay dep h,' --;�- ---------.Capacity------------}--------- Dispasal Eieldr Distance from nearest well ...............Distance from foundation---__--_-----.____..Distance.to nearest lot line-----__--__.__... �[ �� Number of lines ----------- Length of each line Type of filter material-------------------------Depth of filter material----------------------.Total length----- -------------------- ------------ Seepage Pit: Distance #o-nearest well----PZW---------Distance fro fou ation d 'el I ��________ Dishy e to nearest lot I�e _- Number of pits... ----.___---__Lining material_- Size: Diameter _?�_-.---__-._-Depth r , i. p , Cesspool: Distance from nearest well---------------- Distance from foundation-__.__. -------- j Lining material ------------- ❑ Size: Diameter__-.c___ -- ;-_ ------------Depth t Liquid Cap acity H -----gals. IiPrivY: Distance from nearest well' .,: ------_-------------_--- - - -_ Distance from nearest building ❑ Distance to nearest lot < Remodeling and/or repairing (describe):---------!-�----. ---------------•---- ------ 1 ---------------- ---------- ------•-- - t _ t _________________________ .__ _ _____________t__._._ _.. ------------------ - ----------- - -, � r � -----------40-.r `� -'--------�kw� ----- y d. + . � i ---------------------------------------------------------- ; 1 herebycertify that I have Y prepared this application and that the wor will 'be`done-in accordance with San Joaquin County ordinances, State laws,!and rules and regulations of the San Joaquin Local Health District. I t {Signed} ---------- ------ r Contractor) - -- By: f -(Title}. r' f .1 " - - ----------- (Plot plan, showing siz : of lot, locati n of system in relation to wells, buildings, etc., can be p aced on reverse side). i FOR DEPARTMENT USE ONLY ;{APPLICATION ACCEPTED BY___.__--__ f -- ---- -------- ----- ----------- -- -- --- -------- DATE----- ------- ------------------------- it REVIEWED BY-------------- - - -------------------------- - - ------------- ------------- _------------------------------ -------------------------------------- DATE-- ------- �BUlLDING PERMIT !,SUED--- ------------- ----------- - -----•------- ------------- ------------ - ----- ------ ---------- DATE----- -- ------------------- --- ------ ------------------- Alter ions,�nd/or recommendations:.. b----- --- - ��✓ 7 -- ----- ---- ------- ------- - -'!` C vCC '� T FINAL INSPECTION BY--- ----- ---- .. ------------ - -------------- ---------- �� 7 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelfon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California r Manteca,California Tracy,California F.P.CD.