13788 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: p APPLICATION FOR SANITATION PERMIT Permit No. _.�.-`3-.7Aa • (Complete in Duplicate) Date Issued /.)— .—- -~ 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 •th County Ordinance No. 549. j��p uA. G JOB ADDRESS A LOCATIO -----•- ------- !'k'Q.�'-- ------- „M,r"Mm- Name -- - --------- Ph one------------------------------------ Owner's Address r< -- - • -------------- Contractor's Name------ ------- - Phone........ Installation will serve: Residence Apartment House ❑ Commercials❑ Trailer Court ❑ Mote! ❑ Other ❑ Number of living units: -- ____ Number of bedrooms --_�.'Number of baths ___j___ Lot size 4-6- -__- -----------------•-• Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table -------- ft. f Character of soil to a depth of 3 feet: Sand E] Gravel E3 Sandy Loam [I Clay Loam ❑ Clay ❑ Adobe 5kO**Hardpan ❑ ' Previous Application Made: (If yes,dote--------A----------) No New Construction: Yes No ❑ FHA/VA: Yes ❑ No Ems— TYPE OF INSTALLATION AND SPECIFICATIONS: : .� - • (No-septic-fank or cesspool'permitted if publi6 ewer is available within 200 feet.) I Septic Tank: Distance from nearest well--1' ___Distan from found tion__-t�_�__-_____.Mater• i_ _ Size_-_ •- � - -Liquid depth------ _K�-_Capacity- No. � - of compartments-.---��__ X- ---- ------ /A___..-_Distance to nearest lot line-_��__-.____ Disp al Field: Distance from ne t welL___�___.__-- Distance from foundation..._ _ Uri Number of lines______ Length of;Wli Width of trench-____�_�--______--_- O g I Type of filter material___..__ _ Depth of filter material__:_- -:�-��--___Total length_____.__ (, _-_ -- ------•-•- = Seepage Pit: Distance to nearest well----------------------Distance from foundation___...-------------- _______.... Distance to a s o lin ________________ A ❑ Number of pits----------------------Lining material--•--------------------Size: Diameter.- D - ------ --- --•--- - Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material__-_-_---..____-_______-_-_____--_ Size: Diameter--------------------------------------Depth_--------------------------------------------------Liquid Capacity----------------------_gals- -- als. .�, ❑ - istance from nearest-building - privy�""'P"�""Distance from nearest - "__:-_ _ �� ----'-•----"-- -- - ❑ Distance to nearest lot line--=-------------------------------------------------------------•----- ----------------------------------------------------------------------- Remodeling ?,O/or repairing (describe):_______________ ___ Il F _._�8...... ----------•------------ ------------------_----------------------------------------------------------------_------_---------._______-_ _ _ ___________ _ _________ _ _ _____________________"____-_____-_-______-___----____________-----____-.__________--______-_-________________--_-_____---______.___________.-__________--________--._____.-.______-_______--___-- ' 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. s�.af' ----------------- ----------------- or Contrac+ (signed)--- - -err -- ---- - ------------�.� / (Owner and -- �- - Title (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------- ----------------------- ---------------- DATE---------------•----------- " REVIEWED BY - P -------•-------- DATE `I '.. "�� - BUILDINGPERMIT ISSUED-------•-------------------- ----•----------- .------ DATE------------------------------------------------------------- Alterafio�s and/orrecommendations: --------------•-------------- -------------------------- •------------------------•-----------------•---------•------•-----------•----------------------------- -•----••-------_--------- ° ------------- - - ---- ------•----------------- --------------------------------- - --- --------- FINAL INSPECTION BY:. Date------------ --- - C- -- 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 E8.9 REVI6EC 9.59 F.P.CC,aM 6.6C