13313 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: Permit No. ... . I APPLICATION FOR SANITATION PERMIT � ---------------- ----------------------------- --------------------------- (Complete in Duplicated Date Issued -------_-----------• __.._-_---------------------------------------_____._-_ This Permit Expires 1 Year From Dat0ssued Application is hereby made to the San Joaquin Local Health-District for a permit to construct and install the work herein descrbed. This application is made in compliance with County Ordinan9p No. 549: ti� ---------------------- _ ___________________________ JOB ADDRESS AND LOCATION qu `" 11 _.,. `� = Owner's Name-----�----- -------------------------,---- Phone Address -----.--------------------------------------------------•----------- ---------------. ---------------- Contractor's Name---`---- r Phone..................... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .___ Number of bedrooms -at- Number of baths _. •. Lot size .�Ple _I ----------------------------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ft_ Character of soil to a depth of 3'feet: Sand ra❑ `Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe lardpan ❑ Previous Application Made: [if yes,date3-1'�4� ) No' 0"New Construction: Yes g`lo ❑ FHA/VA. Yes ❑ No 9�-- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feed.) Septic Tank: Distance from nearesf well___et---____Distance from foundation-__ _ Material___ __LI�!JI--L ` -....... --- No. of compartments__ -----------------Size.t _ �-------Liquid -__ei, ------------Capacity+.- ------- depth p Disposal Field: Distance from nearest well_'__ __...-Distance from foundat•on___�`Y-___-.---Distance to nele arest lot 'ne_:��_ ...... 1� Number of lines:_______ - Length of each line__ __ ____________Width of trench._ ____� ____._________.. Type of filter material Depth of filter material____,&_ -i Total length______.�__Q________________!___._ Seepage Pit: Distance to nearesf,well_.____*r't-------Distance fr m foundation------142......Distance to nearest lot line__��~ - ,/ - _-Size: Diameter__ `. Depth, Lining mafierial._ s.�✓ ---- e P ----------- Number of pits Cesspool: Distance from nearest well-----------------Distance' f rom foundation----------------__..Lining materia------------------------------------- ❑ Size: Diameter--------------------------------------Depth---- -----------------------------------------------Liquid Capacity-----------------..........gals. Privy: Distance from nearest well__�.`_____ _ __�___' ,----_�_-,Distance from nearest building____________-________-..-._____________- a 4. -: '� ❑ Distance to nearest lot Fine"------- -�-�---------•• -- -------------•----------=---------------=------- ••--------._._----G�i�/�l� ----------------- AR, Remodeling and/or repairing (describe):'._____-- / _ ' -----------------------•-- --•-----------------------------------------------------------------------------------------•----------------------------------------- ----------•--------- ----------------------- - 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 ru s and regulations of +he San Joaquin Local Health District. (Signed) `f ------ f sr Contractor) ----------------- ------- - - - - '. - -------------- - - ----------- - (Plot plan, showing size of lot, location of syste to relation to wells------ --------------•--- Title----, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY q - DATEfREVIEWED BY-------------------- DATE-------•-- -r-------- BUILDING PERMIT ISSUED------------ ---------- ------------------------ DATE Alterationsand/or recommendations-------------------------------------------------------------------------------------------------------------•------------------------------------------------- ---------------------------------------------------- ------- -------------------------------------------------------•-----------------••-------------------- -----------•---------------------------------------------------------------- ------------------------------------------------------ ------••---------•--- -------- *� --- ------ -- ------•-- ------------- ----------•----------------•----------•--------- ------•-------------- -------- FINALINSPECTION BY--------- ----- ----------- ----------- - Date----------- 1. ------------------------------------- ------ 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 a Tracy,California E6.9 REVISED B-59 F.P40.SM 6.60 }