12579 - Laserfiche WebLink

Home Browse Search

F n FOR OFF( E USE: , 0------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. . _s__�_y ---------- (Complete in Duplicate) a ��- p / __ �' This Permit Expires 1 Year From Date Issued 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 compliance with County Ordinance No. 544. JOB ADDRESS AND LOCATIO ---J� --�--�--------- ------ --------------------------------------- Owner's.Name---- G7?t. lvit OJ ...... ---- ---------- :__.. -------------- Phone........ Address---------7 ill - Contractor's Name---�----• ----73---------------•-•--------------•-------------------`-------- :_...... f Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer. Court ❑i Motel ❑ Other ❑ Number of living units: _..1___ Number of bedrooms ,2_ Number of baths A ,__`Lot size -----------------•• Water Supply: Public system j�__Community system ❑ Private ❑ Depth to Water Table . . `ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ - Clay ❑ Adobe 0--Hardpan ❑ Previous Application Made: (If yes,date___:__,-:..,__.___--) No gr New Construction: Yes j2V`Ne,[f FHA/VA: Yes ❑ No R4— TYPE OF INSTALLATION. AND SPECIFICATIONS: F(No septic tank or cesspool permitted if public sewer is available within 200 feet.).f i Se �4 Septic Tank: Distance rom,.nearest well-_ A__�._.....__.Mate�riai__�ICe_____________________ _:__----------- P �n-�___Dis}ante from foundation_1 EL No. of compartments.._._2-----------------Size----------- _TS. -�__--Liquid depth------<----------------Capacity... p4�-r� ti Disposal Field: Distance from nearest we(I_�=-----:_Distance from foundation/j&�* ....Distance to nearest lot line__ � Number•of lines--------'_::-2--------- Length of eachfit,._-F__..._..Width of trench.---- :_`.'------------------- Type of filter material_____ LA _----Depth of filter material-----'jam_'--------Total length________�_a_'------------------- ____ --- Seepage Pit: Distance to nearest well_:____--__-_Distance from foundation---/e.; sem-..Distance to nearest lot line_!t_- c"� Number of pits___-__.__!___________Lining material...__ Size: Diameter-_ .X - _ De � 4`-------- -- --- P Cesspool: Distance from,nearest'well___'___---------Distance from foundation--------------______Lining material-------------------------------------- 1771 Size: Diameter------------------------------------.Depth--------------------- -----------------------------Liquid Capacity---------_-----------------gals. I Priv Distance from nearest wel----------------------------- _ --------------------Distance from nearest building----------------------------------------- � y. ❑ Distance to nearest lot line----------------------------------------------- ------- --=----------- -- ------------------------------------------------- Remodelin and/or repairing describe :------- ------ J /Ili r-•------ � --------- ............. f'�Rm__1T- RfgNTF_I> UND �'�-----M—NDf7-)a-�----._r_ ER,D E Ay_� - ----- �----�`i.1�1�---�� -'-1?�.M_�Gt_��1?r--•--=�--- --��- -�-`C�.--------� ---- --- --- --- ---- ------------ - = = /------------------------------------------------ ! hereby certify that I have prepared this apphca ton and'that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and reg tions of the San Joaquin Local Health District. (Signed)--------------------------------- ------------- - - ---- -- -------- ------•------------------=---•------------------••------- -------------------(Owner and/or Contractor) By: --------------------------:-- ---- =--- -- -- ----__(Ti+le)------------------- ---------------------------- ------ (Plot plan, showing size of lot, location f syste in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----__1k ...... --- -------------------------------------------- DATE----- Q------------------------ REVIEWEDBY----------------------------:5_Er�----- ------------------------------------------------------- DATE-----------------------------......................------=-- BUILDING-PERMIT ISSUED--------------------------------------------------------------------------------------------------. DATE------------------------------------------------------------- Alterationsand/or recornmendafions:------ ---•---------- ------ '-------------------------------------=-------•------------•--•- -•-------------------•------------•---------------------- -74 ---------------- ----------------------------------------------------------------------------- ------------------------------------- -----------------•-------------------- -------- ------------------ ------- FINAL INSPECTION BY:- _- . . .... Date----------/ c� rp ------------ ---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 405 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California 1 ,y E9-9 REVISED a-59 F.P.CC.7M 6.60 • }5 -�-fes t