13243 - Laserfiche WebLink

Home Browse Search

FODOWE USE: �1 a�APPLICATION FOR SANITATION PERMIT Permit No. ...1_ _ .7 ---- ------ (Complete in Duplicate) G� 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 with County Ordinance No. 549. Am NJ JOB ADDRESS AND LOCATION.��- -----I' IRP.ORT----- _K.7..,--------------------------------•-----•-------•------.---------------------•------------- Owner's Name..............NiEwmv reIl.4l------•-------------------•---------------------------•--- ............................................ Phone.................................... Address................................................................ ---------------•............ •-------...----•-------•--•--...•----...... Contractor's Name---------------------------I••-----==----•-----•--- ...................................•--•---------------•-•-------------•-•-------•------. Phone........................ •-----•-- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel (3 Other sR Number of living units: ---._._`Number of bedrooms ---I---- Number of baths ---f_... Lot size ...,Z.r`x J P_.._ Water Supply: Public system ❑ Community system ❑ Private [Depth to Water Table 95ft. Character of soil to a depth of 3 feet:', Sand Gravel ❑ Sandy Loam Clay Loam [:] Clay C] Adobe❑ Hardpan ❑ Previous AppKcation Made: (If yes date----. _- No B''�New Co uction: Yes E] No ❑ FHA/VA: Yes E] No 15� TYPE OF INSTALLATION AND SPECIFICATION (No septic tank or cesspool permitted if pu or is available wifhtri 200 foot.) Septic Tank: Distance from nearest well--------- _-- Distance from foundation---149----------Material...1CAN<A.F_T ...... No. of compartments.._--_-''2 .....Size' XjA__ _._--Liquid depth....-..- --------------Capacity..... �a.-_._ Disposal Field: Distance from nearest well-- -------Distance from foundation.....1.0.......Distance to nearest lot line....f0_.... Number of lines.-_.�---------------------Length of each line__---_.ifs-.�� Width of trench-----.2�.----------- .41- Type of filter material.._..Rock -Depth of filter material------1_-_-------Total length------------------- ........ Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line.-............... 1 `7 ❑ Number of pits......................Lining material-..__---..-..-.._--.--.Size: Diameter.---........---...--...Depth................................. , Cesspool: Distance from nearest well-----------------Distance, from foundation--------------------Lining material...................................... Y ❑ Size: Diameter--------------------------------------Depth--------------------------------•-------------------Liquid Capacity............................gals. Privy: Distance from nearest well--------------------------------------------------Distance from nearest building.......................................... ❑ Distance to nearest lot line---------------------------r✓------------------------------------------------- -•---------------------.......................... -•-------- Remodeling and/or repairing (describe):- ----_._- - ------------•-------f--------------------•----------------------------•------................................... -------•---•--- ------------------------------------------------------------------------------------------------------------------------------------------•------------------------------------------------••----------------------•--------- ----------------------------------------------------------------------------------------------------------------------------------------•-••---•------•-•--••......••----•...•-----•........_.. 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. Owner d (Signed)-------------------------------------------------------------------------------------------------------------------------------------------------------------------( and/or Contractor) By:....................................................................................................................................(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------ j�'� ................... REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE............................................................ BUILDINGPERMIT ISSUED-------------------•------------- -- . •-•------•.•------------------------------------------- DATE............................................................ Alterations and/or recommendations .-- ------- -•--- ------.. • ---•----- ---•• . ----•-•--- •---- -------•------•---•••...--•---•-------•-•------- ------------------------------------------------------------------------------------------------------------------•------•--•-----•-----•--------•••-••-=••••--•--------•---•---••--•---•-•-------..............-•-••---•-•-. --------------------------------- •------------------- ----------------------------------------------•---------------------------•----------= ----------------------................................... -------------------- ------------------------------ .......... ------------------ ---n__ .. ... ......................................................................................................... L FINAL INSPECTI ..-- -- --- ---- -----V.- Date------ ..'to SAN JOAQUIN LOCAL HEALTH DISTRICT f 130 South American Street 300 West Oak Street 124 s,-camore Street 2051 fest 9th Street Stockton,California Lodi,California rt *ca,California Tracy,California ES-9 REVISED a-69 F.P.CD.7M 6.60 S