21131 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ------------------------------ �z-r APPLICATION FOR SANITATION PERMIT Permit No.�l..J ....... - --------------------------------------------- --- {Complete in Duplicate} Date Issued ___ _____ - 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 compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION-, ^ --- -------- .- - 1- = .:. - - Owner's Name----- 1 ----------•l-1A -7-g—jQ-Al---------------------------- - ---- ------------------------------ ------- Phone.----------------•--------------•--- Address---- - / M� ------------- ------------------------------------------------------------ ---_-------.------------------------ 's Name_ - 9�-� S 6T �/V-.L�_.----------------=--------------== --------------------------------------------- Phone4&61%.6.77------ Contractor Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ._.___ Number of bedrooms I/ Number of baths . ____ Lot size -------------------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table �P.Q ft. _�. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ ,Clay Loam ❑ Clay ❑ AdobeX Hardpan ❑ Previous Application Made: (If yes,date............------..) No ❑ New Construction: Yes ❑ No ML PHA/VA: Yes ❑ No f TYPE OF INSTALLATION AND SPECIFICATIONS: . -1 1 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i Septic Tank: ��ry Distance from nearest well----------------- from foundation-_.____.r-.-_-.--.Material----------------- -------------------------__. ❑,E5G6544A No. of compartments------- ----------------Size--: t (Liquid dep? h----------- Capacity----------------------- Disposal Fie#d: Distance from nearest well_________________Distance from foundation:-------------------Distance to nearest lot line--------------------------------•-- 19 Number of lines-- ------- -------_. .._.._Length of each line___2,.0----'=---------Width of trench.-.Z�rr- Type of,filter material__ ___ ____ ______ __Depth of filter material--------/-_X----...Total length------74p---_______-_--_._----_. i Seep e Pit: Distance to nearest weIL.j001_&,__Distance from foundation-_-_I�__----.Dist +ice to nearest lot linel.15----------- Number of pits_ i-�--Lining material-_��.� _ Size: Diameter__4 _.------_-Depth_ III-___________________ Cesspool: Distance from nearest well-----------------Distance from foundation____-----._.______.Lining material-------------------------------------- ❑ Size: Diameter----------------- --- ------- - Depth-------------------I-------- ---------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------` -,.;--------e--"----Distance from nearest building-----------------------------------------. rte,, ❑ Distance,to nearest lot line------ ------------•-I°-------- ------- ------- -•------------- ------- ------------------------------------------------ ------------------- Remodeling and/or repairing' describe):~_. '-.. a �_ ra--- i f - ,r� U �� _.: � -�-- ---------- I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State les and(regulations of the San Joaquin Local Health District. `� -L .------ Q-� ------- {Owner and/or Contractor) (Signed).- �' By=-------------------------- `' ----- '- ----------------{Title} - (Plot plan, showing size of lot, location of system in relation o wells, buildings, etc., can be place on reverse side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- ---- � -- ------------------------------------- DATE-----------X7!71 ----------------------- EREVIEWED BY----------------------------------------- - - --------------------------------------------- ---------------------------------- DATE----------------------------- ----------------------------- BUILDING PERMIT ISSUED----------------------------------------_------------- - -__ - DATE------------------- Alterations and/or re ommendations:-_fV?�G, .-.. ---- - - -------- -------------------.----------..-------------------------------_----------------------.-------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ---------------------------............-----------------------------------------------------------------------------------------------------------------------------------------'--------------------------------------------- FINAL INSPECTION BY:- ---- ........ Date---- -------129a-/ -V------------- --------------- ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 9.Hazelton Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ' F.P.C O. -