12728 - Laserfiche WebLink

Home Browse Search

FOR OFFICESE: ` • APPLICATION FOR SANITATION PERMIT Permit No. -------------- --- ----------------------------- -------- (Complete in Duplicate) . _______._-_ --- This-Permit Expire s 1 Year From Date Issued Date Issued .._._____7.....__.l 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------U(_4------ ----------- ------------- ------------------------------------...------------------------------------------- i Owner's Name i�a'-4 .LF,tz- �..a�`l .k_ ak - - �. -- ------------ Phone--------------------_-------.---- ,T . t Address-----=��--�'I�-=-P--------------------------------------------------------------------------------------------------------------------------------------•-------------------•--••-•--••-•---------_...... Contractor's Name_z&,V_ --- -`----= ----------'--C.f "K Phone........ Installation will serve: Residence ❑ Apartment House F] Commercial 10 Trailer Court [3 otel ❑ Other ❑ Number cf living,units: -------- Number of bedrooms ________ Number of baths ._-.-'(Lot.size -__A?.`-X.- -Q____________------------------ # Water Supply: Public system E) Community system ElPrivate E&-Depth to Water Table ft a Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam.❑ Clay Loam ❑ Clay ❑ Adobe ER—Hardpan ❑ Previous Application Made: (If yes,date--------------------1 No ❑ New Construction: Yes ❑f No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: !. (No septic tank or cesspool permitted if public sewer is available within,280 feet.) Septi Tank: '� Distance from nearest well_________________Distance from foundation__._'...............Material------------.--_-______________________.________- No. of compartments--------------------------Size---------------•------------•---Liquid depth--------------------------Capacity_-----•------------_ Disposal Fier' Distance from nearest well----------_____-Distance from foundation_':'....-_._______.Distance to nearest lot line________.._._.__. [eA�f Number of lines------------------- :--------Length of each line----------_------------------.Width of trench---------------->------------------- Typo of filter material_________________________Depth of filter material-----------------------Total length_______________________ L ..__Distance from foundation -".Distance to nearest lot line___6______.__ Seepage Pit: Distance to nearest well___/0�.____.__ � [ Number of pits._-__=.------------Lining material_�L_C-/_..-Size: Diameter____7.0__y----------Depth------ _,,2__,,f'_____________ Cesspool: Distance from nearest well_________________-Distance from foundation____._____________.Lining material----------------._-.___-_________..__. ❑ Size: Diameter------------------ =---------� Depth--------------------------- Liquid Capacity .gals. Privy: Distance from nearest well------------------------_------------------------Distance from nearest building-------.--._.----_______-_____._________- ❑ Distance to nearest lot lire------------------------------------------------------------------ -----------------------------------------------.........------ ------ Remodelin and/or repairing (describe):_ ti____ �. --_ 7�---'--------------- ----2:_ Ll!___• �_.-_4_______ f _ - ____---___.______-___-_____.__.____________�_;_. __ _____......_._________ ___________ -------------------------- ----------- ________-____ ._ I hereby certify that I have prepared this application and that'the work will be done in accordance with San Joaquin Count�G'' ordinances, State laws, and rules and gul ions of the San Joaquin Local Health District. (Signed)---------------------------•--------- -------- -- ------ ----------------- -----------------------------------------------------------------------------(Owner and/or Contractor) By: (Title) (Pllot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). Y FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-_ il ---------------- - 7 � mDATE REVIEWEDBY------------ ` --------------r------ -------------- ---------------------------------------------------------------- DATE------ --------------------------------------------------- BUILDINGPERMIT ISSUED---------------------------------- ------------------------------------ ------ DATE.------------------------------------------------------------ Alterations and/or recommendations------------------------------------ -- =-------------=----------------------•----------------------:------------------•-`------------------------------------- ---------------- ------------------------- --------- ------------------------------ ----------------------------------------------------------------------------------------------------------- 41- FINAL INSPECTION BY:. - Date------ r� rP --------••------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California E6-7 REVISED 9-SP F.P.CC.2M 6.60