13685 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ------------------------- ------------------------ ------------------------------------------- '_ .__._______----------------- APPLICATION FOUR' SANITATION PERMIT Permit No. __.+.3.. ----------------=------------------------------ (Complete in Duplicate) f/ ------------ 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. 549. JOB ADD �j✓f 1 1 RESS AND LOCATIO -- ._.. u--�P- ---- `Y` 'f - ' "�'--------------------_---_---------------- Owner's Name e t v .---- Phone-.. ........ -•----- ---------------- --------------- Address-__017.0 -- ��jj r7 + Address iL�� .- ( v Contractor's Name-----... Q --• ............... I.---- .----------._......---...._.....-------------------------------------------- Phone ................................... Installation will serve: -Resident Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __.L._ Number of bedrooms ... Number of baths --- --- Lot size ..... Y- -'................... t Water Supply: Public system ❑ Community system ❑ Private,- Depth to Water Table Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Ado6e.0 Hardpan ❑ Previous Application Made: llf yes,date-------- No New Construction: Ye No ❑ FHA/VA: Yes ❑ No , r k TYPE OF INSTALLATION AND SPECIFICATIONS: (No'septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_____ d Distance from foundation ----- M rf i ............................... No. of compartments ---------- �1►-f __.__Size__t_��_Liquid depth_..__.th1_____Capacity-J,..��, j Disposal Field: Distance from nearest well.../_O!_ ... Distance from foundation ...-��...... Distance to nearest lot 'lif e. JJ�_._ Number of lines__...._.Length of each line --..____Q_.5�_._ _____..Width of trench___•�� '7 1�..."�...__ ` ----- 11,15- Type of filter material._.�_�__�Depth of filter material_______) _________Tota! length__._..Z,t_d_______________________ Seepage Pit: Distance to nearest well ---------------------- Distance from foundation ............... ..... Distance to nearest lot line ----------------- El i Number of pits_-------------------- Lining material ----------------------- Size: Diameter ........................ Depth .-------------------:: Cesspool: Distance from nearest well ... -------------- Distance from foundation -------------------- Lining material ----------------- .-------- --_-_---.-._-_.._...._ N Size:Diameter--------------------------------------De th---------.--------------i id Capacity_. ❑ ' � P ----------------------------- Lu - _ q �........... -----_=-__.gals. ' Privy: Distance from nearest well------------------------------------------- -----Distance from nearest building ............ .--..__••---.----------------. ❑ Distance to nearest lot line ----------------------------------------------------------------------- -------------------- ._.-_....-----••----•----------------------------- Remodelin'' 'I 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 rules and regulations of the San Joaquin Local Health District. (Signed)---------•--------------- l' _..... ----------------(Owner and/or Contractor) BY: ! �j--------------------------------------------------------------------- (Title).....-------•------------------------------- --- -(Plot phin—".sKowing size: of -loft; location of`system e+c.; can Fel"placed on` reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----------------- ---------------------- C---------� .. DATE --------------------------------------- I S REVIEWED, BY------------------------------------------__--------•-------- 7 _ ,�.._�lr.. DATE -- - ------------- BUILDING `.PERMIT ISSUED---. --- •------------------------------ �------- DATE -- ---- Alterations".and/or recommendations:----------------- -- ------- ----------------------------•-•----------------•--------------------....---------------•--•--------------•----------------•-•---._.. -•-•--------------=----------------------•------------------------------------------------------------------------------------------------••-•---•-----------------------------------------•----------------- .......... I ............ .............. 9C --------------------- --------------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION $Y: -------- ------- ------------------j. � __ Date ------------�-��------------------ -----------------._..___ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton, California Lodl, California Manteca, California Tracy, California E9 9 REVISED -0-59 2M 6-61 At LAB F�'�•'-