13696 - Laserfiche WebLink

Home Browse Search

I } y ,_ I 0 --------------------- -" ------------ -------------------------------------- ------- ------ --------------- - APPLICATION FOR SANITATION 'PERMIT Permit N (Complete in Duplicate} f ----- This Permit Expires I Year From Date Issued Date Issued ._.. . .��' jl 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. x. js� 03 JOB ADDRESS AND LOC TION---. - - ----_------------------ Phone....Owner's Name.... •' Address____ . --------------------•--------•-•-•------••-•---- d--•"-••.. . COntrCtof's''Mania...... -�' "' Phon Q_". .. . . Installation will serve: Residence � arfm e t House ❑ Commercial [G*Trailer Court ❑ Motel ❑ Other (] E t. Number of living units: .-..-. Number of bedrooms �" Number of baths ---A-t Lot size,.:--- .. r d `��s � � . 'tis' ! -a WatertSupply: Public system ❑ Community system ❑ -Private Depth"to Water Table - Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe4!��Hardpan Previous Application Made: (Ifyes,date-- ----------------) No ❑ New Constructicn;�Yes`e_No ❑. FHA/VA:'Yes ❑ No [+� TYPE OF INSTALLATION'AND,SPECIFICATIONS..,,.* (No septic tank or cesspool permitted Iif public sewer is'available�wit n 200.feet})��. � »• Septic Tank: Distance from nearest wellly ,� -_.Distance`from!foundation,rer, __"".Ma#liar.- p r .--' Size"_ 4-.?S_ "(��C.w_.Li_uid depth"-....--' -- ------Capacity-e�211LZ No. of com artments""""- _"_-. , Disposal Field: DistancNumber of lines`"'rfrom est well_ ��` -_ Dist� � ro � �� ,--------- lot t ! Length of a ch Ilnedatlo?�-------Widthcofttrenches ,(�----------------- Type '�_-..-_------ # 7 e of filter material. . -Q_ '-' I � YP i 1� G./�"""----Depth of filter mater�al----�-------Total length---;....�'L7-------------------•-:-- See a e Pit: Dlstance,,to nearest well from foundation_...................Distance to nearest P g 'lot line................. Number of pits----------------------Lining material-----------------------Size: Diameter._._.....---------"-_.•:Depth""-.`•...-.----------:----.---.-.- Cesspool: ( ` Distance from nearest well---------------t Distance from foundation-___-_-_------__---.Lining material..................................' __ *. A. ❑ i Size: Diameter--------------------------------------Depth-- ---------------------------Liquid Capacity--- .......................gals. I! iI Privy: Distance from nearest well--------------_------------_-_----.--------.-__Distance from nearest building j - ❑ �� Distance t� nearest lot line.-__ Remodelin and/or repairing; !,Z scribe - � -" 5 i r s�i eq h x • ® �- � �, ...fo _.. ...�--------'---�'---------------------- -- I I hereby certify that I have prepared this application and that the work will be don in accordance with San Joaquin County ordinances, State laws, and!rules and regulations of the San Joaquin Local Health District, i (Signed]_" .. s_ [Owner arrd/or Contractor) V �E By=--...••.t--•---•---------• -•••.4-•-------------------_----------------------------•---------------------------------------{Title)--------------------------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). r r a FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 8Y._- �_4,--- ----------------------------------------•----------------------- DATE--/,/• '' r -± .....-------- REVIEWED BY - -=------------------ ------------------•---------------------•••---------------- DATE---•-'--•----•-----••-- --- l % BUILDING PERMIT ISSUED "`= --------------•--•-------------------------------------------- DATE_------------------- -----------F t --------------------------- Alterations and/or recommendatlana: w�• ----------------- --------------•`------------•------'- -------w"`-----------..------••-------•----•------- # '' -- ._. ; --••-------•---------------------------....... ------------------------------------------------------------------------- ------------ --- •--------- -- ---------------------•--- -----------•------------•-• ------------------------------------------------------------------ -------FINAL INSPECTION BY:-- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 144 Sycamore Street , s 405 West 9th Street w " Stockton,.California Lodl,California Manteca,California Tracy,California ES 9 REVISED 8.59 2M 5-61 ATLAS