13031 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: r. " .......... .......................... . ------------- APPLICATION FOR SANITATION PERMIT Permit No. ....1.._.J 7I (Complete in Duplicate] 4-a This Permit Expires 1 Year From Date Issued-0- - - 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 N 54 JOB ADDRESSLOCATION ✓� Owner's Name = ---------- - ----- - ----------------------------------- -------------- Phon�ra'.. ��-7-_��...... Address---------' 1 !u�s! �) ---------------------------------------------------- Contractor's Name � _'j -- �---------------------------------------------1_1--------------------------------------- Phon�. I Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel E❑ Other ❑ Number of living units: .,_._ Number of bedrooms _ Number of baths -{- -- Lot size ...,xL"9_.., -----3'.c-n---------------- ---- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table,�/,r, ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ' Hardpan ❑ Previous Application Made: (if yes,date--------- ----- --_1 No [�` New Construction: Yes E] No0 FHA/VA: Yes E] No F-1TY E OF INSTALLATION AND SPECIFICATIONS: / No septic tank or cesspool permitted if public sewer is available within 240 feet.) Distance from nearest well______ ----------Distance from foundation--------------------Material __".......-____.____....---._-- ,❑ No. of compartments----- --------Size--------------------------------Liquid depth------------------- _ ----Capacity------- ------ � Distance from nearest ell__ ...-t--Distance from foundation._©7_�----...-Distance to nearest lot line.---s _�..... ©� Number of lines-----------,--------"-_Length of each line---._:3e-. -.--- ---- Width of trench----- ------------------- T e of filter material..�1_ Depth of filter material____-- /.�---_.._Totaf length.---__-..._.:..__�e-- --------._ Seepage Pit: Distance to nearest well-ja£-____-t...Distanoa m fo ndation... .0..f.._...Distance to nearest lot line..------ .._ [ � Number of its---.-- ........Lining •" p � --Lining materiaL�,r�-��...Size: Diameter------�- ----------Depth_----,�-�------------- Cesspool: Distance from nearest well----- -----------Distance from foundation___________________ Lining material-_._...--------.---.._._.._-_------. ❑ Size: Diameter.......- -----_- ------------------ -Depth-------------- ------------------------- ----------Liquid Capacity---------------------------gals. Privy: Distance from nearest well____________________ ____________--------------Distance from nearest building.---------.----------------------__ ❑ Distance to nearest lot line--------- ---- -- - --- - Remodelingand/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, Stat ws, and,rules nd regulations of the San Joaquin Local Health District. (Signed)_- - .° :----- . ;------ '.(Owner and/or Contractor] �" `E %_ �. Title BY - - -------- - (Plot plan, showing size of lot, location of system in relation t ell's, buildings, etc., can be placed on reverse side). FOR DEPA TMENT USE ONLY APPLICATION ACCEPTED BY_. ------------------------------------ DATE----------- ----- REVIEWEDBY ------------------ -------------------------------------....--------------- ---------- DATE BUILDING PERMIT ISSUED-------- ------------------------ ----------------------------------------------- - ----------------- DATE Alterations and/or recommendations:-------------__-_____----------LL- _ -- ------------------- ------------- ------------- FINAL INSPECTION BY ...__C.-: l ate .` SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 134 Sycamore Street 705 Wast 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E9-9 REVISED 5-59 r.R.00.zM 6.60