13265 - Laserfiche WebLink

Home Browse Search

FOR OFFICE SE: S. ��G A ,. �f O �( z APPLICATION FOR SANITATION PERMIT �� ` Permit No. -------------------------- ----�� /--/a (Complete in Duplicate) ( y Date Issued --��'� L----�'-� ______________________________�-Lz-tel___ _._ 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 Ordinance NQ. 549. JOB ADDRESS AND LOCATIONA4 ` � '-zrC%�'�' � = r Owner's Name yy -----/ r Phone -20 > ( _ h�Address --- Contractor's Name----------------/ ------------------------------------------------------ -............................. Phone...........------------.....-----.. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Mgtel ❑ Other ❑ Number of living units: .-/-- Number of bedrooms -Al—. Number of baths _ _: Lot size 410-!��L_leo.................................. Water Supply: Public system [Community system E] Private E] Depth to Water Table .�1rft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe el-nardpan ❑ Previous Application Made: (if yes,date---------------------), No gr New Construction: Yes ❑ No g?"FHA/VA: Yes ❑ No 14.— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available withinQQ feet) Septic Tank: Distance from nearest well-----^'^-_-- Distance from foundation--'- Mateial1r: '$ � !------------- WOONo. of compartmvde- _ _ � p _Aoi ��G� Capacity Disposal Field: Distance from nearest well------ ---._Distance from foundatio A��.� _._.Distance ta,nearest lotline..s�'�_ ....... Number of lines________ _____ ___ __�__'__ _ Length of each line___ _ �l,...:Width of trench----.e�R. ;__.___.____._____..._ Type of filter material__ Depth of filter material 4 .-Total length t'� . or Seepage Pit: Distance to nearest well______""=___-__Distance frQrn fou dation-/O... _�Distanc�to nearest I t I �ff Number of pits-----/_-__----__-Lining material.__ G..Size: Diameter____ 6.-__-.-___Depth._.................. Cesspool: Distance from nearest well-----------------Distance from foundation.----------------_Lining material Size: Diameter----------- -------------------------Depth---------------------------------------------------Liquid Ca aci - ' Privy: Distance from nearest well-------------------------------------------------Distance from nearest building ----------------------------------------- 171 Distance to nearest lot line-----------------------------------------------------------------------••--••--••-• ------•-•-•----•----•--=--------------•--------- ------ L �� .ra7_ Remodeling and/or repairing (describe):-----.-_----..__All- l`" � �4�---_y •-'-.--- -------------------------•---------•-------------------------------------------------------------------------•---------•----------------------------------•---------.............................................. ••.... ----------------------------•- ---------------------------------------------------------------------•------------------------------•---------------------------;------•- ------ ---------------- 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. (Signed)------------i le ---�41/�tG'f---- •.. -- - - Contractor] By:...............................-----•--•••... (r+�) •�'Gri ----------------------------------------- (Plot -------- ------- ------- (Plot plan, showing size of lot, location system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE OtJIL _N APPLICATIONACCEPTED`BY....C:......y ---------------------- ------------------------------•----------- DATE--- �-3 t-.-_-------------------- REVIEWED BY------------------------------------------------------------------------------------------------------------------------------ DATE................. .._.. -------------------------------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------_--_--- DATE..........................t -------- --- Altetati s and/ recomme dations -.__ _ _. _ ._ _ _--- ............ ......... --•-•••. --- ------ --- ---- ------------------------------------------------- ------- .------------------------------------------------------------------------------------------------------------ FINAL INSPECTION BY:..---C-- ! -----------_----------------- Date------b ' __Z_ (Q.j.•.---------------------------------------- SAN JOAQ.UIN.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 Ee-9 REVIVED 9.59 r.P.CD.2M 6.60