13197 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: --- ----------------------- _/ ---------------------- �r n 7 _--/.---�•./-_---___.___ A�' __ APPLICATION FOR SANITATION PERMIT Permit No. ._ _., _ ,l -------------------------- - - - (Complete in Duplicate) 3 __.________-_____ __________ ___ This Permit Expires 1 Year From Date Issued Data Issued=._r 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 AIIALOCATION----`�� ------ d- --------------------•---•-•-----------------•-------------------.------------------------- Owner's Name------- ----!/y -- ----- -- Phone--------------------- Address---------------- ------ --------------- ---- ---------------------------------------------------------------------------•---•---------•--------------- ------------------- Contractor's Name---- - --------------------------------- ..... Phone__._.....---• --•- - - --- Installation will serve: Residence [L]-Apartment House ❑ -Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ._ _-_- Number of bedrooms ____._.Number of baths __/__ Lot size ._ Water Supply: Public system [Community system ❑ 'Private ❑ Depth to Water Table ft. Character of soil to a depth oil'feet: Sand ❑ Gravel ❑ Sandy Loam,❑ Clay Loam ❑ Clay ❑ Adobe Er--Hardpan ❑ Previous Application Made: (If yes,date.___._____,..__.___) No' New Construction: Yes 2""No ❑ FHA/VA: Yes [GY" No ❑ 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-----/Q--------Material___ _ �- � ___________- 9 No. of comparfinents--- _---:---------_-__Size_] ___ _ __.__:Liquid depth__�J__C_ ` ______Capacity �� I Disposal Field: Distance from nearest well---- ______Distance from foundation..../90_...__--Distance to nearest lot line--------------_- Numb _____... \ , Number of lines__--- -:=_-_=--j---== r---- Length of each line---,� C--p--��-------.Width of trench. - ------------------------ V Type of filter material-- &I Depth of filter material___�p______________Total length ..._-..___... =............ Seepage Pit: Distance to nearest w' 11" frqm foundation__-.,/Q.•7�'.Distance to nearest lot line___t ________-_ [? Numf e� of pits______ _ ____________Lining material._._ _ .G ___Size: Diameter._,, . �'-_--.___.Depth__�r�__-______.______- Cesspool: Distance from nearest well_________________Distance from foundation- -------_-- Lining _ material_______,-_-_______________-._______.. ❑ Size: Diameter-------------------------------------De th-,---------_---------------.--- __ -_---. __Li Liquid Capacity ---gals, Distance to nearest lot"line --Distance from nearest building-------------------------------__________ _Priv Distance from nearest well_______________¢ � Y' ❑ -------1--------------------=--------------- ---------------------------- -------------------------------------- Remodeling and/or repairing (describe):-'---------71 ----•------- ...------•----------- ------ ----------- ----- -- - - - ----- -- -- - -------------- IQC -----------...............i -• --------=----------- ---------------------------------------•-------•-------------------------- ----------- -------------------------------------------------------------------------- ------------------------- ==------------------------;------•------•----.,...---•-•---------------------•-------------------------------------------•-------•-----•-----.------------.----- -_----------------------------- ft -------------------•--------'------ --- _- --------------t----------------'---•------------------------------------------------•--------------•------------------ I hereby certify that"I have prepared Ais''application and that the work will be done in aecordance'with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signe ' ( -g } A = Contractor} 1 -- -- -- ----- ---------- -------- - ---- ------- ---------------------------------(Til1a) �ll/'-------- i (Piot plan, showing size of lot, location of syst n relation to wells, buildings, etc., can be placed on reverse side). "FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ - ---------- --- ------------------------------ ---------------- DATE-----------�T/.:vA-1--------------- REVIEWEDBY---------------------------------- --------------------------------------------------------------------------- DATE_'__.------------------------------------- BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE--------------------------•-- --------•--------------------- Alterations and/or-recommendations:---- = ------=------ -------------- ----------_------------------------------------------------ ..........-----------------------••---------- = r --------------------------- --------- -----------------•-- --- I - 1-/�/------�� c ��f- r�------- =..�- r P1.T`.---- — T AJY_K5_ 1 � �----- ------------------ ....... --------------- UaWf_ ----- - - --- C j-�- ------ ---- -- --- ----•---- - -----AC --------- :--, . - V — r �� FINAL-INSPECTION" Y:-__-.-.-- Qrl "� t" — — Z ��.�.� Date SAN JOAQUIN LOCAL HEALTH DISTRICT {. 130 South American Street 390 West Oak Street 124 Sycamore Street 245 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California / ES'-9 AEv..E.9.59 F.P.CC.1M 6.60 i