13329 - Laserfiche WebLink

Home Browse Search

FOR OFFICEUSE: --� ----- �r Permit No. ...�.>�..�.:�.. - __ ----_---"- APPLICATION FOR SANITATION PERMIT - --------------------------------------- (Complete in Duplicate) Date Issued ------- -------- �•'•- !�/ _-----_----"----._-. This Permit Expires l 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 N0.�5y pQ ----------_------ JOB ADDRESS A ND C ON --- ---------- Phone-------------------•-------------- OwnersNam -- ------- ----- ---------------...................... Address , � Phone----__--•---....---•- Contractor's Name------ Installation will serve: Residence j?-0A"fpartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: /--- Number of bedrooms _ Number of baths -,/--- Lot size _". �f�- -ZAP-------•-----•-----•------ Wafer Supply: Public system Community system ❑ Private [:] Depth to Water Table r t• Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe gr Hardpan ❑ I No New Construction-, Yes o : Yes El NO Previous Application Made: (It yes,date"_.--"_.-",-__-.._ ❑ N ��HA/VA TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer.is available within 200 feet.) 4 Setic-Tank:) Distance from nearest well-----------------Distance from foundation------.-------------Material------------------------------------------------- )"01 4my No. of compartments--------------------------Size--------•--------------- --_---Liquid depth--------------------------Capacity--•--------------- Dis osal ield/l: Distance from nearest well-----------------Distance from foundation.----_------------.Distance to nearest lot line----------------- �4� Number of lines---"-------------------------- ---Length of each line------------------------------Width of trench---------------------------------- Type of filter material-------------------------Depth of filter material----------------`---.Total length--------------------------------------- Seepage Pit: Distance to nearest well-____-.�"._""""_-Distance #r m fo ndation...le---�'-.Distance to nearest lot line_. -__".._ . q • Size: Diameter ---------Depthr�.�------• - t� IlX Number of pits----,�------------ 9 21� --- ---Linin material.-/ - �7 - Cesspool: Distance from nearest well-----------------Distance from foundation--------------.----.Lining material------------.-.-_---------------ads. ❑ Liquid Capacity---------------------------- Size: Diameter----------------------------- ------Depth---------------------- ------ - ------------------- 9 Privy: Distance from nearest well---------------"---------------------------------Distance from nearest building---_-------_------_----__---.--.-------- ❑ Distance to nearest lot line-------------------- --- ----------------------------------------------------------------------------- Remodeling and/or repairing (describe)------------------ ----------------------------------------------------------- ---------- - �i'•Vss�i�l'E -------- ------------------•---------------------•-"---------•--------------- -------- I 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. (ENM61=0ftwor Contractor) (Signed)_ 1`\v - ----------- - &11 ---------- By:----------------------------------------------------- ,j { ) [Plot plan, showing size of lot, location o stem ' relation to wells, buildings. etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY---------------------------------------------- - --- -- ------------- DATE------------....------;--pA----------------------------- REVIEWED BY DATE-------- !,'Al------------------------------------- --------------------- ---------------------------------- BUILDINGPERMIT ISSUED------------------------------ ---- -------------- DATE.-..------------------------------------------------------- Alterations and/or recommendations------------------ ---------•------------------------------------------------------------- -- -----•-----------------•-- --------- ----------------------------------------------------------------------------------- FINAL INSPECTION BY:...- Date------------- -----------•---------- ------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES-9 REVIBED 6.59 F.P,CO.2M 6.60