18368 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: - ----- - • APPLICATION FOR SANITATIN kEjfi IT . �� Permit No. ---- --�.. _ - / lG -------------- _ � ..--- li in Duplicate) / f (Complete PDate Issued -----_!_A. .h- 4 __________________________ This Permit Expires t 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 compliance with County Ordinance No. 549. JOB ADDRESS AND I,OCATI ..N`. `: -----�- _rte .----Zvw/ ------------------------------------ -------- Owner's Name________________ ______ < ------� - =-----._,��-------�_ ��-----------------------------------._. Phone-��--� _� .� Address------------------------�--� -- .� � - -�'_R'.5-�1----• ----�i4i4!�---------------------------------- - ---------------------------------------------- ----- - ------ ---- - ---,-L Contractor's Name ------ -----�. f '_l__~_,- - ----------------------------------------------------- Phone_-l�l�------ Installation will serve: Residence .[[• Apartment House [❑ Commercial ❑ Trailer Court E] Motel ❑/ Other ❑ Number of living units: rl__ Number of bedrooms _.-7-Number}of baths --- --- Lot size -------u_C9------X--_____- �._____._.___.- Water Supply: Public system`E/Community .system ❑' Priva,te`` �❑ 'Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam [] Clay Loam [;R�Clay ❑ Adobe ❑ Hardpan ❑ S Previous Application Made: -(If yes;date---__ _f:___-__.-) No New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No [;i � k I 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 foundation----....___.-__---Material----.----------------------------------.____-__-. ❑ No. of compartments-- ------- ---------------Size---------------------- ----..Liquid depth--------------------- ---Capacity-------------- ____Distance from foundation_--.1_�_ '___.Distance to nearest lot line - ___-_ � Disposal Meld: Distance from nearest well._..,__,- _ Number off lines--------------`-_--/-----•-____--Length of each line-----.f�_--.-._-_- ---Width of trench-- ---;R_f _____._---------- Type of filter of filter material-----1Z--------- otal length_____-_. __________________--- Seepag Pit: Distance to nearest well .-...___Distance,fr foundation._/ __...._--.Distance to nearest lot line-p -__--- 6 Number of pits------- - --•--- g / --- p Linin material- Q°. -- Size: Diameter-_- - Depth J Cesspool: Distance fiom nearest well------------- ---Distance from foundation------------------- Lining material-..-___.._._-__F_--._-_--_----------. Size Diameter -------- Depth----------------- .- Liquid Ca acltY -- as.. i €)istance fromnearest well- --------- ----- ---- --------------Distance from nearest building --------------------------------------- El stance to nearest lot line. - -- Di ---- --- ----- ---- -------------------------------------------------------------- - ----------------------"`-- Remodeling and/or repairing (describe):--------- `:'�-_ 1.71 ---_----->—"?------- , '__lam'_/.- , -•----- ,1 ---------------------------- -----•--------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------- r -------------------------- ------ ------ -------------------------------------------------------------------------------- --------------------•--------------------- ------------------------------------------------ — ---------------------- ----------------------------------------------------------------------------—--- — ------------7----------------------------------------- �k whe clone I hereby certify that I have prepared this application and that the willT -in accordance with San Joaquin County ordinances, State and rules and regulations of the San Joaquin Local Health District. (Signed) ..1.__.. _ f .----------------------------- --- nes /or Contractor) B -- ------- ---- (Title).-- +---- -- -_- ---- -----_ Y� '�� (Plot plan, showing size of lot, location 91 system in,relation to wells, buildings etc., can be placed on reverse side). 4 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --------------------- DATE.------� I�� G._ _' REVIEWEDBY------------------------------ ----------------------------------------------- ---------------------------------------------- DATE-----------------------------------.------------------------ s BUILDING PERMIT ISSUED-------------- ------ DA•TE------------------------------------------------------------- Alterations and/or recommendations:_ r ��.- . t�J Y-----•------------- `;--'----------------------------------------------------------------------------- 4 ---------------------------------- -------------------•------•----------------------------------- - ---------------------------------------------------------------------------------------------------•--•--•------------- M --------------•--------------- ------------------------------ --------------------- ----------------------------- -----•------------------------------- - - - ----------•---------------- --- ---------------------------------------------------------------------- -- ------------------------------------------------------------- -------------------------------------- ------------•---------- -------------------- ------------------•---------------------------- -- ------------------------------------------ FINAL INSPECTION BY: ..._.. ----- Date---------/ - ------------------------------- y . _ .-. --- -- ---- _ . � SAN JOAQUIN LOCAL HEALTH DISTRICT r i 1601 E.Howelton Ave. 300 West Oak Street 124 SycamoreStret%. 205,West 9th Street Stockton,California Lodi,California Manteca,California �' Tracy,California ^f. � AV f F.P.CC. f' f if