13548 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: Y ----------------- ---------- -�L APPLICATION FOR SANITATIOPERMIT Permit No. _.�...�. ___ _ N e _._ - ---- --- - - --- - l _--------------------------- - -_-_._.__. This Permit Expires 1 Year From Date Issued 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 No. S49. JOB ADDRESS AND LOCATION----/�-- r /----- f Owner's Name--•-----------------e'l!f'-�-------7., 1.--...... fL^!t ------------------------------------------------------------ Phone- Address hone Address----------.6. -f7 f l r 1 ----------- ------------------------ Contractor's Narne__._ ..-- �- � �------- Phone .. Installation will serve: Reside nce;,'f_,Apart,e' nt House ❑ Commercial ❑ Trailer Court ❑. Motel ❑ Other ❑ Number of living units: _Number of bedrooms 2_. Num6er of baths _ Lot size .__-/ " ----- ----- Water Supply: Public system l7r-Commuriify system ❑' Private ❑ 'Depth to Water Table e:Dp 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------------_-------- _) No ❑ New Construction:-Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tan r cesspool permitted if public sewer is available within 200 feet.) iK; 11K. fi Distance from 'nearesf well_________________Distance from foundation._______________-_Material________----_-_-______._ 'No. of compartments---•----------------------Size-----------------------_--- ---Liquid depth----------- --------------Capacity---•-------------- --- Q aSal ie Distance frorh nearest well_tAo_M_C'__.Distance from foundation....sf______ ______Distance to nearest lot line----.-- Number ine______ �_. � Number 'of lines__________/ Length of each line-__:_.. __Q__'___�f._.Width of trench------- 'rr��-------�_ d �.: „� Type of filter me Depth of filter matenal.______1 ________Total length_____________________________ *. _ _�. O ' a W Seepa a Pit: Distance-to nearest well't`�o_1'1..Q----Distance from foundation__________________.D�sfance to nearest lot line_______.__.___._ Number of its--.--- .____-'-------Linin material____ 4�_____.Size: Diameter_ -- _ Depth.... r i Cesspool: Distance from,nearest well--------------___Distance from foundation._._-------__.___..Lining material-------------------------------------- ElDiameter--------------------------------=-----Depth----•---------------- --------------- -------------Liquid.Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------- from nearesf building-------------------------..._____.______-- Distanceto nearest lot line--:--------------- --------------------------------------..----------------------------------------•---------------------------------------- Remodeling and/or repairing (describe)------ ---------- ---------- ------ ----•------------•-••- -----••---•-•---•--------•---- ------b ------------ --------------------------------------= •-------------------------•- ----- -- ------- -_-____-_-_-_-_-----------------------------_--------_•-_---------_-------_---_--:- .......... .-- -__ _:: :: I hereby certify that I have prepared this application and That the work wit! be done ' accordance with San Joaquin County ordinances, S la and rules and r gulations of the San Joaquin cal Health District. § Con+ractor) [signed} f ---------------------- ----•- gY: -------------- :--------- ----- • -•---- )-...--------------------:------- - a (Plot plan, showing size of lot, location of system in rela to welts, buildin , et , can be placed on reverse side). IN - FOR EPARTMENT USE ONLY APPLICATION ACCEPTED BY---- - -- ----------------------•---------------- DATE- `.. _�.--- U REVIEWED BY -•----------- -'-------------------------- DATE-.-.----------------------- ------------------------------- BUILDINGPERMIT ISSUED--------------------------------------------------------------____ '---•--------------------------- DATE------------------------------------------------------------ Alterations and/or reco fdalons:.. � cel � ---------_-- •-------- ---. --- --•-•---------- 2- -�— - ---------- - ...:.. ...--------------- ------------------- ---- ------------------------------------------------- --------- -------------------- ---------------------------------------- ---------------------------------------------------------------------------------------- --------------------- ------------------------------------- --------------------------------------------------------------------------------------• --------.------------------------------------------------------------- 2 (o FINAL INSPECTION BY:-J-'.- -- -- --- ••-------��.--------- Date------- C -•---• -------------------`----�------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stocktonr CalifOrnla Lodi,California Manteca,California Tracy,California EB9 REV16Eo a-99 F.G.CO.2M 6.60