13862 - Laserfiche WebLink

Home Browse Search

FOR OF ICE USE: 1-- G & __ APPLICATION FOR SANITATION PERMIT Permit No. ./..,�;r1. .:,' (Complete in Duplicate) -Date Issued .� "--�- ---I- -- ------- --- This Permit Expires 1 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 inance No. 549. JOB ADDRESS AN LOCATION �. Owner's Name - -------------------------------------------- ............................................. Phone--� y-••---. Address................... �7-M-4 -,� Contractor's Name----- .. � ` " S-----T�........................................................................................... Phone............................ Installation will serve: Residence Utr—Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ....._- Number of bedrooms 4— Number of baths ...I--- Lot size -7A-.X..2...-t-r-Q.......................... Water Supply: Public system Community system ❑ Private4EAKepth to Water Table .5, :31t'. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay,❑ Adobe❑VF(ardpan Previous Application Made: (If yes,date---------_----------) No [ New Construction: Yes gr`�No ❑ FkA/VA: Yes ❑ No 51-- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi Tank: Distance from nearest well-----------------Distance from foundation....................Material....__...._._.._._............................... No. of compartments--------------------------Size................................Liquid depth------------------ ------- Capacity....................... Dis sal Fi ` Distance from nearest well_________________Distance from foundation....................Distance to nearest lot line................. Number of lines-----------------------------------Length of each line......................._......Width of trench................................... Type of filter material-------------------------Depth of filter material-----------------------Total length.......................................... p"r Seeps It: Distance to nearest weII4--------- ion.#p.�.._.__..Distance to nearest lot line.: ,.cm f..........of pits-----........#--______Lining material.-<-__.Size: Diameter.7.e _ Depth_______-�T..Z............. N 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 lin ------------------------- ------ ---------•• •--•••.... •-- �-------------•---/----------- ...................F Remodeling and/or repairing (describe): r_ l'--- -----. s....-- I .. ........................ ----------•-------•------------------------•-------------------------------------------------------------------------------------------------•----------------..--------------------••----•-•-•-----•---•----•---•--._...--- 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 re ulati s of the San Joaquin Local Health District. (Signed).................................................... --•--• ----------- --------------------....................................................................................(Owner and/or Contractor) By:............................. -• .. •--- ••-•--•----••------••-------••--•-----••••-•------••-•.(rii+le)................................................................ (Plot plan, showing size of lot, a+ion o sys+em in relation to wells, buildings, etc., can be placed on reverse side). F R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_.. x---= - ------ -------------------------------------------------------------------- DATE--- r - REVIEWEDBY....................................... -- --------------------------------------------------------------------------------- DATE............................................................ BUILDINGPERMIT ISSUED-------- ------- ----- ---------------------...................................... DATE............................................................. Alterations and/or recommendations:-----.-------------------------------------- ---------------------•----------------------•----------------------------•-----•••---•-•--...... ............... --•- --•-•--•- •- ---- -- ----•------ -- -------- ...--•-•-•......................................................... -G .. ...... •••-••..................•....... ...-••-------•-----------•--•---•----.......................••....... FINAL INSPECTION BY: ------- --- • --------- - -------------- Date........9117 _ -v .._..------------------------------ 3 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 REVISED S-S9 RM 5-61 ATLAS