12584 - Laserfiche WebLink

Home Browse Search

FOROFFICE USE: -------------------------------- ------------------- ------------------- ------------------------ -------- ------------------°------------------------------_.--_---.-.-----.----_--- APPLICATION FOR SANITATION PERMIT • Permit ------------- •----------------------------------------- (Complete in Duplicate) Date Issued -- ----------------------------------------------------- This Permit Expires t Year From Date Issued 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 comliance with County Ordinance No. 549. Q�cj_0�p �. q .� r JOB ADDRESS AND L CATION_/yZ=, Owner's Name .........--o2l!elz A ---- Phone-- Address--------------------------A40 Gt 2 - (��31 �X-_- -_Gc�_cu�?�_ 'f=--------------- •------- -•-•..... - Contractor's Name------------------ -----------•--••---- ----------•-- ----------•---------•------------------------------------------=---. Phone----------------------------------- Installation will serve: Residence IN Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --/..__- Number of bedrooms __1�2_ Number of baths -------- Lot size .3�r1 -�.- - f?-�X! !r_3`fIP/ Water Supply: Public system ❑ Community system ❑ Private K Depth to Water Table -- --- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date---------------------) No" New Construction: Yes No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if pubric sewer is available within 200 feet.) Septic Tank: Distance from nearest well--6.-_.--.----Distance ro Faun /fion_--_�G--/---.Material---------=- f z�-�(-'_--:-_._ _.. No. of compartments-----------�----------Size--- ._..�.•- t�_ Liquid depth---.-, -------Capacity...,. . Disposal Field: Distance from nearest well_.-._5T.....Distance from foundation----j_0-9--_-Distance to nearest lot line,.- Number Number of lines---_____i- -- --..__ Length of each line_---____-_. -�. Width of trench.----- --_ }} - „ Type of filter material--- 0�___.Depth of filter material------_It----------Total length---------- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line__--------------_ ti AElf 17 Number of pits----------------------Lining material----------------------_Size: Diameter-----------------------Depth-------------------------------.- 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----------------------------------------- 't' ❑ Distance to nearest lot line----------------•- •---------------------------- ----•-••-------------I---------- % Remodelingand/or repairing (describe):------------ ---------------------------------------•-----•------------------------•-•---------•---------------------------------------•--•------------- ------------------------------------------------•--------------------------•----•-•---------------------------------------•------••-------------------------------------•--------•----------------------------------------- 1� ----------------------------------------•--------------•------------------•------------------------------•------------------------------------------------------------------------------------------------------------------ --------- -------------------------------------------------------------------------------------------------•--------------------------------•-----------•---•------------------------------------------------ --------- - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State I ff, and rules and regulations of he San Joaquin Local Health District. -! d (Signed)__-__ ----- .-- D------ ------------------------------------------Owner and/or Contractor; By:------------------------------------------------------------•---------•--- -------------------------------------------------------(Title)----------------- ----- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). EP TME T USE ONLY APPLICATION ACCEPTED BY.---------- ---------------•---- --- --------- -----------------------------.-------------- DATE..... --- �. REVIEWED BY----_-------------------------------------- ------------------------------------------------------------------------------- DATE--------------- BUILDINGPERMIT ISSUED--•------------------------------------•--------------------•----------••------_-------------------- DATE------------------------------------------------------------- Alterations and/or recommendations---------------------------------------------- •---------•--------------------------•-----------------------------------------•------•--------------- ---- ----------------------------------------------------------------------------- ------------------------------------------------------•-------•------------------------•-•-.-----------------•----------------•---------------- ------------------------------------------------------------------•-•-----------------•--•--•- ---------------------------------------------•--..-.-...--------------------------------------------------------------------- ----------------------------------------------•-------------------------------------------------------------------------•-•--------------------------------------•---------•------------------------------------------------- FINAL- INSPECTION BY:--- --- --------- ----- ---------- ----------- -------------- Date---- -----------41 - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Strset 20S West 9th Street s' `Stockton;Cofifornia �� Lodi,California Manteea,California Tracy,Californip E8-9 REVISED 8-59 F,PX0,2M 6.613