13668 - Laserfiche WebLink

Home Browse Search

FOR OFFI: E+LJS s L -------- ----------------- ----------------------------- -------- APPLICATION FOR SANITATION PERMIT Permit No. _..T.... ......_... .. --------------------------- ------------------------ -- (Complete in Duplicate) Date Issued ._I.(-..I —(-e ( ------------ ------ - . This Permit Expires 1 Year From Date'Issued Application is hereby made to the San Joaquin Local Healfh District for a' permit to construct and in�st/�11 the work herein described. This a iicati ri is made in compliance w h Coun r i anc No. 549 6 C 710 � Z c�.z{lam p �; vr1 �' �.�s �C ' �� JOB ADDRESS AN LO ATION•.-- ----- -•• - ----------- - -•- ....... -- -------- � �'------------------------------------- Owner's Name--- Phone --------------------------------------------------•-- --------------------------- Phone --- -----------.......-------------------------- ----- Contractor's Name---------------- ---:-- ------------ Phone..----•--•---------•-- .. ------------------------------------------------------------------ ----------- Installation will serve: , Residence R'Apartment,House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _J_-_ Number of bedrooms ._;; Number of baths __-/__ Lot size26V_'�-_eYL ------------------------ Water Supply: Public system [L_�Community systemE] Private [-] Depth to Water Table - ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel Sandy Loam E] Clay Loam E] Clay ❑ Adobe 93-'14ardpan ❑ Previous Application Made: (If yes,date-----t_-----------) No �New Construction: Yes 91" o ElFHANA: Yes ®-- No [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 we-III __ ____Distance from;'foundation__._/�.�....Mater'al___-&_4.,�,�-6C �� --_.-. - �-� , No. of compartments______ ___ ___ Size.__-__-___X__�,P_,-._.___Liquid depth-----� _---._.._.__Capacity_r 4_ ........ Disposal Field: Distance from nearest well----:7=-------Distance from foundation-----l-4'__._.Distance to nearest lot Number of lines----___/------ -----------------Length of each line-----__Q Width of trench__A_`,----------------------- Type _,---_____ ___-.__... T e of filter materialf /4?4*-IG-De-Depth of filter materia =— Yp 2 - - - - -- p ��----------• -Total length----- --�---------------- •-----•---- Seepage Pit: Distance to nearest well-------- -------Distance from foundation_,-`-Z�..-.__-_.Distance to nearest lot line..-Lz..... Number of pits-----l_--------------Lining a niateril_-_ -_._/ PG --Size �Diameters y_ ---.Depth---'z-'��--------------------- Cesspool: Distance from nearest well-----------------Distance from foundstion--------------.-----Lining material__._-__---_-_--_------___ ❑ Size: Diameter-------- =-----------------:----------Depth-----------------';--------------------------------Liquid Capacity------------------------_--gals. Privy: Distance from nearest well----------------- -------------------------------Distance from nearest building---___-__-_._.__.-_----___---_----------- Distance to nearest lot line-- - --- --- --- -- ❑ ---..---- . - - - - -- -- ----- ---•-----.-..:....--------------•------••------- ---•� --- ----- Remodeling and/or repairing (describe):---------- ------------- - -------------------------------------------------------- ------ --------------------------------------•------------ ---------•-•-----------•--------------------------- / t t ;. ------------------------------------- ----- - -----•----- -•-----------------------------------....------------------------------------------------------------•-------------------------------------------------- I hereby certify_that-I.-have prepared this application and +hat the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of +he San Joaquin Local Health District. {Si ned �/ s 9 )•--- = (�or Contractor) -- -- Title) d ham'..---------- By: ( )----- (Plot plan, showing size of lot, to ton of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTME T USE ONLY APPLICATION ACCEPTED D BY- -----=---------- DATE------- ....- REVIEWED .BYE---------------------------- ----------------------------------- --------------------- DATE------------------•---------------- = --- --- --- BUILDING PERMIT ISSUED =!:- - DATE -------------- ---------------------- ,_, - �jAlterations and/or recommendatii ns:.._ __ - _____________ __ 4�rE:. fl:-�_:_:(_1.. ,/ •--•• -------------------------- .---:. .•-•_......-.• ------------------------------------------- } ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:... �'�- - = Jncti Date------- f.-. ' --•----------------------•---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 203 West 9th Street I Stockton,California Lodi,California Manteca,California Tracy,California EB-9 REyl9(C a-S9 F,P,r D,gM 6.60 -