12603 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR ,SANITATION PERMIT Permit No. ..,AAi2_-3 \ (Complete in Duplicate) 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. 549. JOB ADDRESS AND LOCATION....t7 (e 4---------- ., ._----------------------------------------------------------------------------------------- Owner's Name------W- -;tL-A------- tt -- -------------------•----------------------- -------------------------------------------- Phone._ Address------------5we–.-V--5--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Contractor's Name----- --------------------------------------------------------------- ----------------------------------------------- Phone................................... Installation will serve: ,Residence Ej Apartment House ❑ ~Commercial,❑ Trailer. -Court-.0_ Mel ❑ Other ❑ Number of livin6 wits: __ ___ Number of bedrooms--_ Number of baths ---I---- Lot size -------------•-•---_---_ Water Supply: Public{sysltem Community system ❑ Private ❑ Depth to Water Table (o(? ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobej& Hardpan ❑ Previous Application ade: Yes ❑ NgQ New Construction: Yes & No [:] FHA/VA: Yes ❑ No`R TYPE OF INSTALLAT. ECIF,tMTMSc'' (No septic tanklor cesspool permitted if public sewer is available within 200 feet.) 1 � Septic Tank: Di to'nce from nearest well---LnQ-_----Distan a fro oundation-----1-O_--------material+____� ___________________ '® N of compartments........... 1, f t Liquid depth-------'4'�_--__---_Capacity---S.00c?_- J Disposal Field: Di ane fro�n_nearesf kve11 Ca[?' 1�isTance ftom_foundation�.ctQ_.t_ 1; Lli`staii "e to nearest lot line._..._...... '�. Nu bar of lines__ -_-_Length of each line-z- ll idth of trench--_-- -'4_-------------------- Ty `_'----------------- S -----�–� Tye of filter material..------ __.Depth of filter material-----J_-9_.._.__.__..Total length_____---__-13-�� Seepage Pit: E ri,�6hce to nearest well----------------------Distance from foundation....................Distance to nearest lot line................. A ❑ -Number of pits----------------------Lining material-----------------------Size: Diameter-------------- -----Depth-----------.__---------------.--- Cesspool: is ce from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- ❑ SiDiameter------ -----------------------------Depth---•------------------------------------------------Liquid Capacity--........................gals. Privy: Distante from nearest well-------------------------------------------------Distance from nearest building-_--__--_-_-___-___-_._--_._-.----__--. ❑ DistaN e to nearest lot line------------•--------------------------------------•---------------------------------------------------------------------------------------- Remodeling and/or repairing describe):----------------- ------------------------------------------------•--------------------------------•-•------•-------------------------------------------- --•-------•--------------------------------------- ---------------------— _,.__.._..,.-..,._s,...,, -u -------------•-•---•--------•------- ---------------•--•---•--------------------------- I hereby certify that I have preparbd this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and reg tionf of the San Joaquin Local Health District. (Signed)........... ------ ----------- --------------- ---- --------------------------<~ i----- ---------Owner and/or Contractor B : ------------Title ` (Plot plan, showing size of lot, location of sly a in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- -._-. : _ ' DATE....._ -.._�__ _�_ REVIEWEDBY------------------------ -----( . 5 ------- - --------------------------- DATE----:---- •-------------------------------------- BUILDING -----•-------- -- -- BUILDINGPERMIT ISSUED------------------•----------------t---------------------------------------------------- •-------- DATE----- ------------------------------------------------------- Alterations and/or recommendations--------------------{---- ------ -------- ----------------------------------------- --------- ------------------------- -------------- ----------------------------- ...... 1 ---------------------------------------------------------------------------------------------------------------------------------------------------- ------------------- ---------------------------------------------------- - ------------------------------------------------------------------------ --------------------- FINAL INSPECTION BY:...G' � - Date. --------'-�------- -�---- -------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak St eft 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, Cal' is /\ Manteca, orn:ia f / F j 7Tr!ae.,y, California t�EC 4 � r/ Revise F.P.Co. 1,�,;, ,�IC.