12624 - Laserfiche WebLink

Home Browse Search

FOR OFFIC USE: ' - ----- �� Permit No. ._a..a.. •a__.y.. - 3 � APPLICATION FOR SANITATION PERMIT ----------- (Complete in Duplicate) Date Issued ---- -7 ' This Permit-Expires 1 Year From Date Issue Application is hereby made to the San Joaquin Local Healfh 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 LOCAT ON__�q_____kf----_-- -----•-- --------- ------- Owner's Name----•- 't''' Phone Address-----.�Y- ��` � _� - ----- -I--------•---•-•-----------------------•-----•-•- --•-----------------•-- -----•- 1 Phone.-----------_--------•--•------- Contractor's Name------------- ... •--------- Installation will serve: . Residence ❑—�Apartmen't House:❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ g �' -7------.... (Number of living units: __-'>f___ Number of bedrooms _.L_._ Number of baths __f__-. Lot size --•--- Water Supply: Public system ®Community system ❑ Private ❑ Dept to Water Table ,�'f#. Character of soil to a depth of 3 feet: Sand [:] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Q--Hardpan C] Previous Application Made: (If yes,dote--------------------) No,14 New Construction: Yes 2T No FHA/VA: Yes ❑ No J� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest ---Distance from foundation___��_... ---_-•_-,Material__.-__��__.�"��-��------------- � No. of compartments----2—-----------------Size-----3s[ -- -- Liquid depth----.` -•-------------_Capacity--- D l � ism , Disposal Field: Distance from nearest well_=sir? f..._Disfance from foundation----f..__-y'1��.Distance to nearest-lot I�ne______________=�-� 0� Number of lines----._°-�_---�------------------Length of each line----,12------:--------.....width of trench.---`.-....•-----.------------- ` '--------- Type of filter material__..---> - Depth of filter material-----�,i°--------,=--To#al length___--T�____.. ..----•-----•• j Distance to nearest to line-- .-. Seepage Pit: Distance to nearest*well__ ti(.-___-Distance from foundation_ l..'y° - : ®� Number of pits.__._--_I.---_____--Lining material---- G-l[ Size: .Diameter_____ ----....Depth----- ' Cesspool- Distance from nearest well-----------------Distance from foundation._._._._--____-.___.Lining material__-____._____.________..______.----- ❑ Size: Diameter -----.Depth----•------ ------- Liquid Capacity--------------- ------------gals. Privy:° Distance from nearest well------------------------- -----------------------Dista ------- nce from nearest building------------------------------- Distance to nearest lot line----------------=---------- ❑ ----------------------------------------------------~ I i t Remodeling and/or repairing (des-ri e):--------------------------------------------------------- ----------------------------.•-----------. ' ---------------------------------- y _------ - ----�------- ----- -- ---=---------------------- •--------------=----- -------------------------------------------- ------------------- I --- = --------------------------------- ------------•------- - --yam----- _� M hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances. State laws,`and rules and regulations of the San.Joaquin Local Health District. (Signed)---------£-------- -----------------= --:------------ -------------=----------------------------- ------{Owner and/or Contract ---- By:--.,-! . -------- � -----------------------------------------------(Title)-----._ - --------o� (Plot plan, showing size of lot, location 0 system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEP RTMENT USE ONLY l ACCEPTED BY----------- --- _------ ----------- APPLICATIONDATE. - �D_=e �l: cocJ r DATE.. REVIEWEDBY-------------=------------------------------ ------ x --------------------------------- DATE------------------------------------------------------------- -------------------------- --PERMIT ISSUED ------------- . rations and/or reco ndation .---------------=---- ------ ------ --•---------•-- -w ----I------------- ----•---- -------------•------------------•------- - ---- — --- 2� r :- --------------- ----- -- J -7 -------------- . : _ : ::: -- ::: `.-_: .-._�:_:.. :: :::---------------- -------- --•--.----.------- -_-----•- .. ---------------------------------------------------------- - - -.--- FINAL INSPECTION-BY:.�- -------------- -----------J Date------.�Z- ,14-14------ ----------------------------------------- k T SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street 3;. Stockton,California Lodi,California Manteca,California Tracy,California ria-9 REv1e6o B-69 r.P.CG.2M 6.60