12891 - Laserfiche WebLink

Home Browse Search

r FOR OFFICE U E: Permit No._,._lf�.-- . CATION FOR SANITATION PERMIT . -------------- - ------------------------ (Complete in Duplicate) 1. � ; Date Issued ._� *' -----„ __------"---------- ------------- This-Permit Expires 1 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 compliance with County Ordinance No. 549. ��_,��- ,� - T•-------------------------------------------- JOB ADDRESS AN &Ld TI N ----•------- ;------- ---- ----Owner's Name----- r,,.1- Phone: Address----------------- _- �'e All- j �� .- ----- ' 9 i Contractor's Name------------------_- Phon . �� Installation will serve: Residence ❑ Apartment House ❑ Commercial_❑ Trailer Court ��Motel ❑ Other ❑ . e � f i, Number of living units: _r2_ Number of bedrooms . Number of baths __ Lot size '_--_o-- Q----- --• �� ' Water Supply: Public system Community system [I Private ❑ Depth to Water Table ________ ft. Character of soil to a dep+h 3 feet: Sand E] Gravel C1Sandy Loam'❑ Clay Loam ❑ .Clay ElAdobe�i " Hardpan ❑ o Previous Application Made: (if yes,date___--------_--------) No ❑ �_New,Construcfion: Yes ❑ No FHA/VA: Yes ❑ No El TYPE OF INSTALLATION AND SPECIFICATIONS: r a r (No septic tank or cesspool permitted i-public sewer is available within 200 feet.) f C a -C- Distance from --' -- - a ,/-- �Material_ E Septic T No of compartmentst_Well-----:-- Dis#ancq orrt foundatioq �•--p p- �! r * Capacity./A,_ Size- --Liquid de thi ----- _ Disposal�ield:. Distance from nearest well__ ____ Distance from foundation.__ _-a--------- Distance to nearest lot line� �-------- Number of lines__________ _- ------1: Width of trench..- `_'.___.__.-._______--.-- - Length of each line_____ �--------. Type o filter material_S'1__A�( - Depth of filter material______? ----Total length'____ _________________----------- + I r Seepage *t-- Distance to nearest well__l� ---Distan r in f ndation___ } y .____.Distance to nearest 1ot'l`ine---�_ -------- ® Number.,of pits______ ___________Lining`rnaterial_: :_ _ __Size: Diameter__ _ Depth_._ , , Cesspool: Distance from nearest well_- _____-_-`Distance,from foundation---------------------Lining material------------------------------------- ❑ Size: Diameter------------------------------ 7----.Depth----------------------------------------------- --- Liquid Capacity gals. i ___-_Distance from nearest building c , Privy: Distance from nearest well --------------------------------_ - 9 -----------`----�-'------------------- ' Distance to nearest 4ot line----- - _ ----µ --------•-- ---------------------------------------------------------------------- Remodeling and/or repairing (describe) --------- ---------------------------------- '------------------------ --------•---------•-------------•-------••------------------• ----•-----•--------• •--------- ,. ------------------------------- -----•-- --------•-------•-----------------••---•-•----- .._---'---__..-----`---------------------------------------ter_-_--'------•--.. ta 1 ------------------------------------------------------------'------•----------------- I here certi that i have prepared this application and that the work,will be done in accordance with San Joaquin County ordinanc S tel s, and,rule and reguI t'-ns of the San Joaquin Local Health District. 01' (Signed). ----- - -- -------------•---------- --------------------------- Owner and/or Contractor) ----- Title. -----_-------------- --- (Plot plan, showing size of lot, location of system ' relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY --------------------i -------------- APPLICATION ACCEPTED BY--- - .- ---------- -------------------- ---------------- DATE----?:- -_-------------------------- ----------- REVIEWEDBY------------------------------------------------------------------- -----=------•--;-------=--------• DATE--=-----•------...._------------------------ IBUILDING`PERMIT ISSUED----------------- ------- ------------------- ------------- DATE------------------------------------------------------------- Alterations and/or recommendations:------a---`-----:-------------------------------------------- ---------------- ---------------- ---•---------------•- -•-`-•--•--------------------------•- --------------------------- --------------- ----` - - -------_---------------------C---- ---- ----------------------- ---------------------------------------------------- ------ _ e--� - ----- ---- ----- ----------------- - ---------------------------------- ------------------- --------- - - �;, FINAL INSPECTION BY: .--L_' . Date------ ` �G / ------------- ------------------------------ SAN JOAQUIN LOCAL. HEALTH DISTRICT 130 South American Street Soo West Oak Street 124 Sycamore Street 205 West 9th Street I Stockton,California >` Lodi,California Manteca,California Tracy,California E5.9 FEVIBEO 8.69 F.P.CO,2M 6.60