12599 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PRM1T Permit No. .. Z5;�-� (Complete in Duplicate) This PBrmlt Ex fres 1 Year From Date Issued �( Application is hereby made to the Son Joaquin Local Health District for a permit to construct Date Issued _.__. J This application is made in compliance with County Ordinance No. 549. Z�r_and install the work herein de scr ©d JOB ADDRESS AND LOCATION.._ Owner's Namets------ .,/ +-------_____________ - Address__ - • v : ------ -- j -P--hone. on ractars Name �- •-----------------•- •-----•----•-----------•--•--•-•-...-•---- Installation will serve: Residence �/] Apartment House [] Com-m:ercia l ElTra- Tra-- -iler. ---C- ------ourt--- -------•- Phone---------------- ----••------------ Number of living units: --- Number of bedrooms -4 Number of baths _l__ Lot size Q tel 0 Other ❑ Water Supply: Publics stem Y ❑ Community system Private ❑ Depth to Water Table -_� ------•------- Character of soil to a depth of 3 feet: Sand ---- ft. Previous Application Made: Yes No ❑ Gravel ❑ Sandy Loam �Cjay Loam ❑ Clay New ❑ Adobe❑ Hardpan ❑ TYPE OF INSTALLATION AND S❑PECIFIC❑ATIONS:Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ (No Septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: � _ p tante from nearest well-----------------Distance from foundation__-___-__ - �� N. . of compartments-------------- ----- ---Size.-------•---- • - ----- Material_----- ------ �----------........................ ------------------Liquid depth- Ca acit Disposal Field: Distance from nearest well -(�_-- p Y--•-- --------------- C� ance from foundation 1�- _/ Number of lines__I_____�-rte __ LengthDistance to nearest lot line___'o_--n".", Type of filter ma#eriaL-- f of each line-------- --------- --TWidth lalthof length french_._ .f!___ Seepage Pit: I ll ` _-Depth of filter material_____ ------------- t Distance to nearest well-____________________Distance from foundation___--__-._. ❑ Number of pits---- ______._-_-•----Lining material---------------------- ---•----Distance to nearest lot line________________ Cesspool: Size: Diameter._.- ------Depth--- ---------------------------- i ❑p Distance from nearest well-----------------Distance from foundation--------------------- material_____..____ Size: Diameter-_-! - - ----- ------ -------Depth----------------- ------------------ -------- ---------------- --------------- .�... Privy: Distance from nearest well---------------- - Liquid Capacity----------------------------naN, -----------------Distance from nearest bOi ling__ fl ❑ Distance to nearest lot line------------------ - - �.- -_------------------------- ___'--� Remodeling and/or rep g,,�escribe):_4-�_j0c - _ ' -------=------------- t-------------- --•----•-•---•-----•------------------------------------------------------ - I hereby certify that ! have prepared this application and that the work will be done in accordance with San Joaquin Coin+y ordinance St a laws, and rules n regulations of the San Joaquin Local Health District. P Si ned t ----------------------------------------------------------------------------------------- ay:._____________ _____ (Owner and/or Contract _ (O d/o _ _ or) (Plot plan, showing size of lot, location'of system in relation to wells, buildings, etc., can be placed on reverse side). • __ .. �. (Ti+le)------------------ ----------- . FOR D RTME T USE 9,NLY APPLICATION ACCEPTED BY__._ fAr REVIEWED BY----- ------------------------------ DATE------- ---?�_ ------------------------ BUILDING PERMIT ISSUED ----------------------------------------------- :. ----------I DATE---- ------------ ---- - �,. . Alterations and/or recommendations:__ -i-----------------------------------------------_---•---_•---•�--------------------------------------- ------- ------" --------------------- DATE.- --- ---- ------------•-----. - -------------------------------- ------ ----------- --------. ----- -- ------------------------------------------ = - --- -------------- - ---------------- --------------------------------------- ---------------------- - - -- ----------------------- ---- - - FINAL INSPECTION BY:-...... - _ �/�------------ ------------- Date--- - ` SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street ' Stockton, Californialad132 Sycamore Sfree+ 814 North "C" Street t i, California Manteca, California Tracy, California E$-9--2M Revised 8-'S9 F.P.Co. -