12396 - Laserfiche WebLink

Home Browse Search

FOR OFFICE U E: l IDS ------ � ? ----- APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued ------------- u 'This Permit Expires 1 Year From Date issued Application is hereby made to the Sn Joaquin Local Health District for a permit to construct and install the work herein descri "abed. This application is made in compliance with County Ordinance No. 549, i JOB ADDRESS AND LOCATION-----`------// --------------------------------------- ------------•--------------- Owner's Name--- 7- -- --- -------------------------------------------- -------------- ... Phone... Address---------4�x -� = Contractor's Name--- -----•------------•-----•• on Installation will serve: Residence [3!Apartmenf'House E] Commercial ❑ Trailer Court ❑ Mote ❑ Other ❑ � Number of living units: f. Number of bedrooms .•x•___ Number of baths _ -__ Lot size ____ -------------------- l�J p Water Supply: Public system�U]_Community system❑ Private ❑ Depth to Water Table 6 _ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam`❑ Clay ❑ Adobe Er-Hardpan ❑ Previous Application Made: lif yes, .No ❑ New Construction- Yes [9—No ❑ FHA/VA: Yes 1-1NoTYPE OF INSTALLATION AND SPECIFICATIONS: (No.septic tank or,cesspool permitted if public sewer is available within 200 feet.) ' I r Septic: Tank: Distance from nearest well_��----Distance from foundation__/s_____________Mate`ial___ ____-_______ -_______.. i No. of compartinen#s_. = -%Z--=--, -- ---- Size aC,3 X ------Liquid depth- f----- --.. --Capacity ¢a �"\ Disposal Field: Distance from nearest _______Distance from foundation- AA.---Distance to nearest lot line__�3"..________ 1p ' Number of lines-------tF.-1-ne-----------------Length of each line----.-'.Pf-----------------Width of trench__Z_ _"...--------.-------.- Type of filter mafierial___ QC -------Depth of filter material____./8:_�__-'___:_Total length-"___gam_-`_______________________ 1-1 _. Seepage Pit: Distance to nearest well__________________Distance from foundation__-`w�.. .........Distance to nearest lot line__.._._____-__.__ ►� �/ Number of pi#s------- -------=-----Lining materialE, -----Size: Diameter-----3 3- .....,Depth-----.-a .�---...-------- nearest well_______________ Distance from foundation_________________:.Lining material__.____._____:_=_...___.__.:...____.. Cesspool: Distance from ❑ Size: Diameter-------`---------------------------Depth.-------- - --------------------------------.-Liquid Capacity---------------•------------9als. Privy:` Distance from nearest well----------------------------------------- --_Distance from nearest building_________________._..________--_------. ❑ Distance to nearest lot line----------- --------- ------------------'--••-------------------•----;--------------------------------•---------•---------- ------- S f .. Remodeling and/or repairing (describe):------------------------------- •-------------------- -----" ` •------"------------------------------------------------------------ ----------------------------------- ----------- ________ _ _____________________________________ _______ ___________--_--____..___________-________-.:______-_________.._______________.--____--_____-__________.-_-___._.____________._-_-.__..____..._ 1 I,hereby certify that I have"'prepared this application rand that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and r gulations of theiSan Joaquin Local Health District. (Owner and/or Contract By=--------- ---- ------------------ 't - ----- ------ e_ p �[f tat plan,showing size of ot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- - DATE-------- -----. nj ------------------------- ------------------- ------ • _ . DATE--------k-' REVIEWED BY------------- ----------------------------:- --------- -- --- -- - -- ------------------------------ -•------- BUILDING'PERMIT ISSUED-- -T----_ ---------•-------- ---------•---- DATE-------------- -------------------------------------I Alterations and/or recommendations:'------------ --- ----------------------------------------------•------------•----- --- --. ---------------------•------ 4 ---------- ----------- ---�`o----- ------------------------- r = ------------------- ----• - -- --- - /�== -------- e- ------------- 7' - ''�- j .. ______________-------------_____________________________________"______.__. _ _____________________________ ____ & _______.... _____________ --------------------------- FINALINSPECTION 'BY------------ ---------------------------------------------------- SAN ------- ----- Date_-._(e> 0��0 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 304 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California Ee•9 FEVI6 CC B•�9 F�P.0 D.aM 6-60 F i