13331 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE- . .. ------------------ SE:" -. ------------------ ------------- APPLICATION FOR SANITATION PERMIT Permit No. ... _ _ _7�__f ------------- --- --- ----- (Complete in Duplicate) J _ �". _ � A . _ Date Issued .---_-��•- F Year From'Date Issued _____._.___ .l This'Permit Expires 1 Y Application is hereby made to the San Joaquin Local Health District _.. c pp y q for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. { JOBADDRESS AND CATION--- �� _ ------------------------ -- -------•---•----•---...... -------------------------------------------------------- Owner's ---------------•---------------------- -------------------------------------I------- Phone----...--------------------------- Address.....................' ----•------- --- -t----------------•-------- -r -----•• ............ ..----------------..---•-•--•---------•----------------.-�--•--�---•-•- - Contractor's Name-.--- _ _._ .. Phone........ �.---------------•-------•--- Installation will serve: Residence Apartment House.❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ._/____Number of bedrooms _ _ Number.of baths ._ Lot size - /1 _____________________________.... Water Supply: Public system ❑ C mmunify system ❑ .I Private 2 epfh to Water Table t ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2"1Hardpan ❑ Previous Application Made: (If yes,date_-.__-__._.__-.___) No X93!5 New Construction: Yes �Vo_❑ =FHA/VA. Yes Z!I No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank'or cesspool permiffed ifpublic-sewer is available within 200 feet.)_ Septic Tank: Distance from nearest welL ��-__:Di p .. _ stance from foundation----AO?-------,Material__4_t _4e",E_f��__.._._..... No. of compartments`-,�--------= -----Size"i)6i � �QLiquid depth--•-- --...'---------Capacity-/,24 Q------ Disposal Field: Distance-from_nearest ,well.-�OQ"_.___Distance from foundation----/�______.Distance to nearest lot line- __..... Numberof lines `" :_____ /Length of each line-------- _'_._______.Width of trench-__a �_ ---------------------- Typerof filter material _ T i =Depth of filter material-----« _______Total length----A0_Q--______________________ Seepage Pit: Distance fo nearest`well___ Distance from foundation.....lQ_7Distance to nearest lot line_W�_.�_________- [IY Number of pifs." -------------Lining material---eeP` ---Size: Diamefer- __ "- .---.Depth"--s20?-_--------•--------- Cesspool: Distance from nearest well_____------------Distance from foundation--------------------Lining material____________________ w ❑ Size_ Diameter--- ------------------------Depth---•------------------------------------------------Liquid Capacity-------.....................gals. Privy: Distance from nearest well_________________________________________________Distance from nearest building--.-------------------------------------- . ❑ "Distance to nearest lot line---------------- -. .. _ --------------------------------------------------------- p ------- -------------------- ------------- Remodeling and/or reairin9 Idescribe}:___.__ _-_ <.. - ---------------------- --------------------------------------•------------•-•---..--.-------------------------------------- ----' 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. 4 - Yt(S igned) - -_ . ;�/or Contractor) - .._.. --------------0y:------•-------- .._......--•---.......--• - . (Plot plan, showing size of lot, location of s m in relation to wells,'buildings. etc., can be placed on reverse side). L � ' ' FOR DEPARTMENT USE ONL / APPLICATION ACCEPTED BY-- '--. ' -- ----------- ------------ ---- ------------------- DATE------7------Jf-- ��-I------------------- REVIEWEDBY----------------------'----------------------------------------------- '--------'- =-----------------:--------------------------- DATE------------------------------------------------------------ BUILDING PE=RMIT ISSUED---------=----------A--------- -e------------• ---------------------------I--------• -------------- DATE------------------------------------------------------------- i Alterations and/or ec mmendations: _ =' T ' = = = i - s - 7r 'r ------------------------------•-------•------ k ----------------------------- ----------- ------------------------------------------------------- ----•---------------------------------------------------------- - ----------------------------------------------- ---------------------------------------------------- -------------- -------------- ------ FINAL INSPECTION BY:.�--Q"4__ Date..... . S.`_.� --.-------- C SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street w`124 Sycamore Street. :'�},'-1,k 205 West 9th Street Stockton,Californla Lodi,California Manteca,'California 1 Tracy,California EB-9 REVIBEO B-59 F.F.00.2M 6-60