21119 - Laserfiche WebLink

Home Browse Search

— OR OFFICE USE: " al-7167----------------- IR4r3 Q APPLICATION FOR SANITATION PERMIT Permit No. - - ------------------- ------------- �- ----------- (Complete in Duplicate) Date Issued .� This Permit Expires 1 Year Proal"bate Issued Application is herebymade to the San Joaquin Local Health District for a permit to construct and instal4 the work herein described. This application is made in compliance with County Ordinance No. 549. -----•----------------•--------------- JOB ADDRESS AND CJON ------ ------------------------------------------•----- Owner's Name---..��-�,-- - -jjTT��- 1��. --� �J�'�- ---------------------------------- ---------- -------- - - - ------- Phone.----------------------------------- AddAddress -----------------. ---- ress---•-•-- - 8---- ---�-- -- ----'--=-•------------------------------------------------------------------------------------------------ � Phone.------ ---•-----•-------• ------- Contractor's Name - +-�`�----------- --- ------------- - Installation will serve: ResidenceApartment House ❑ Commer tial ❑ Trailer Court ❑; Motel Other ❑ s Number of living units: ..._ Number of bedrooms ..Number. of baths ../--- Lot size _ ... _ ---------"-----------------•-- Water Supply: Public system Community system ElPriva#e ❑ Depth to Water Tablet. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy L1amE] Clay Loam'❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: (If yes date__..__- } No New Construction: Yes g+ No'❑ FHA/VA: Yesk' No [I V'� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool.permitted if public sewer is available within 200feet.) I Septic Tank: Distance from nearest well---.__...-------Distance from foundation.../R----- -.Ma jreal../_�/'�'d.��r�► �--No. of-compartments ------ Size(�S-.'." -Liquid depth--4k- - Capacity.. ��J�� f V+1 Disposal Field: Distance from nearest well....-- ""_-..Distance from foundation.-Z".$_- _.....:Distance to nearest lot line ..�..-_.___ s Length of�eadh line.. - Width of,trench.Z-------------------- --------- Number of lines_.�...�..-.-_ -�-�--�-�"--- ---""� . . �.De th of filter material....' -7 ----.Total length.. --------------------------•-- Type_of filter materials p Seepage Pit: Distance to nearest well-...- --.._-Distance from foundation....................Distance to nearest lot line---..__------.. --- . De th. Number of pits--- -----------------Lining material------ -_ -____--- Size: Dia,meter :11 Cesspool: D•stance from nearest well_.7"l......Distance from foundation----- ------------- Lining material...____---..__...-___.....____...ls.� r ❑ - ', -Depth. ------ Liquid Capacity gals. Size: Diameter- -- - Privy: Distance from nearest well----------------------------------- ------------Distance�`from'ne-arest building.___-.-.. _....-_-...._. «,,,�:4 w ❑ Distance to nearest lot line - -------------- --------- --------------------------- y y Remodeling and f or repairing {describel ---- r ---------------------------------------------------------------------------------------------•-------------------------------------------- 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) ------_�or Contractor) - - -- -` !IY- --------------------------(Tifile) L `� (Plot plan, showing size of lot, location of syste ' relation to wells, buildings, etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------.--- --------- DATE l-_D r,}.= .�� ---------------------- REVIEWED BY------------------------- ------------- -------------------------------------------- -------- ----------------------- ----- DATE-------- --------------------------------------------------- IBUILDING PERMIT ISSUED----------------------------------- - --------------- DATE--------- --------------------------------------------------- Alterations and/or recommendations:----- .............. ------------------- -------------------r--- ---------------------------------------------------------------------------------- -T7•_7:6_7---------- - ---�� --- — Y ---------------•----- ------------------------------ ------------------------ FINAL INSPECTION BY -------------- —lle----------- Date-------. ,07 �_'--_ -7--- ------- ------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stocklonr California Lodi.California Manteca, California Tracy,California F.P.CO.