21137 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: - -------- IM APPLICATION FOR SANITATION PERMIT Permit No. _-I[ [Complete in Duplicate] Date Issued - Q:71,7 - l J This Permit Expires 1 Year From Date Issued 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 compliantwith County Ordinance No. 549. .r - .—. �- Y_W_7�q �7 oG ' .�--m - oSS -!SD-7.h J013 ADDRESS CATION` _-- ' -------------- -- •----- ------------ F-,t - Owlner's Name------- -- - -- ---• -----•- - --------•-------------•-- ------- ----- - ------- --- - ......... Phone Address -------- A Ph h ------------------- 'I , . , If �wtD Phone-----------•----- •------1- . Col�.tractor's Name--- - ------- .------- ----- - -- -------'------------------ ---- --- ---------------- II Motel ❑ Other ❑ Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Court ❑ Number of living units. "^'-- Number of bedrooms --_' Number of baths --7` Lo+ size -- -- -.--- -- Private Depth to Water Table --------ft. ' Wa.�lter Supply: Public sys+e';� ❑ Community system ❑ Adobe Hardpan Character of soil to a depth-of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ EI New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ PreviousIApplication Made: (If yes,date-----------=--- -- ] No ❑ TYPE OF INSTALLATION ANDSPECIFICATIONS: ' [No septic tank or celsspool permitted if public sewer is available within 200 feet.] Material-------------------- ------ 1 Septic Tank: Distance' from nearest well--_-------------Distance from foundation--- - -- -. - Capacity----_----__---- ` ❑ No. of Compartments--------------------------Size-------•--------------- Liquid depth I Di.�pos Field: Distance from nearest well-_#f- _---Distance from foundation--! - Distance-to nearest lot Gne--S---.------.. :' -_Len Length of each line------- _--_-�- ----.Width of trench_--�---.-------- Numberi of lines--------- ------------------------- ---------�----- -- 9 ', g &,D � Type of filter material-_-- - --- -------Depfh of filter material----- ------------Total length r I J f ,_.. Distance to nearest well v__..-t'----Distance from foundation---.-ti -!-_----.Distance to nearest lot line of pits---------/----------Lining material-----s5---TZ-.--- Size: [Newte•tie,,�_�A-_1? Depth...._/--0---------------------- ss❑ool: Drstancll..from nearest well-----------------Distance from foundation------------------- Lining material p -Liquid Capacity ----------gals. Size: Diameter--------------------- ---------------Depth----------------------------------------------------- 0q P Y ---- _---Distance from nearest building---------------------- Pl1. rivy: Distance from nearest well__--..---- ❑ f Distance to nearest lot line-- ------------------ ------------------ ---------------------- II .I Remodeling and/or repairing (describe)- ------ i "' ------- ------ I ---------------- -------- ---------- ------------------------- I�. �M--- ---------- -------------•---------------------------- ---•-- -----•----------•---------------------------------------------•--- ---- ! I� ` --------------------------------------------- �� I hereby certify that I�have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la d rules and re tions of the San Joaquin Local Health District. E� -------.-..-[Owner and/or Contractor) =--------------- -- - (Signed)y M � jifle)---------------------------------------- ....... ........... I �� sllowin size o --- r B g r� Ilot, location of syste in rela on to wells, buildings, etc., can be placed on reverse side]. (Plot plan, 4 FOR DEPARTMENT USE ONLY �APPLI2 ATIONACCE(' DATE REVIEWEDBY---- ---------------�----------------------------------------------- --------------------------------------------------- DATE BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------ SSUED------------------------------------------------------------------------------•-•---------- -------- DATE Alterations and/or recommendations:--- -----•-------------------------------------------------------------- ---------------•-- ------------------------------------------------------- II - -------------------•------- qM---------------- 1I '�Mi--- --------------- --- ------ ----------------------------------------------- ---------------------------------------------------- --------------------------------------- - I�--------- -------------- --- !IN-. --- ---------------- ------ ----•----------------------------------------------------------- ------------------------------------------ --------------------------- --------- ------------ ----------- ----------- --- - --------------- FINAL INSPECTION BY:- - .- -.-. . ------------- SAN -----------SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha-------Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,CaliForni Lodi,California Manteca,California Tracy,California F.P.CC.