13535 - Laserfiche WebLink

Home Browse Search

/ F(52OFFtE USE: JJ11 --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ........................ {Complete in Duplicate) _( • Cr ------------ ------------------------------------------- Date Issued .--------- ........... This Permit Expires 1 Year From Date Issued (11 /7v-1 i n- Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and insta t e work herein esc ibed. This application is made in.compliance with County Ordinance.No.t549. (So. U �� -5 06 1 JOB ADDRESS AND" CATI ------ - -------?.�r-----I1I----OF---- _........ 5� �'� IPhone Name___-_"_ _ •------•--•---------------------••---------------------------------------•----------- ---••-------•------•---- Address---- ----""�==----- -- -- 2i 7 Contractor's Name -------- ---�------ - --C. -..__..._ P ons.. . --.1 Installation will serve: Residence % Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___1___ Number of bedrooms ._ __ Number of baths --/.- Lot size ------<©_K---2Z-0-------------------•-- Water Supply: Public system ❑ Community system 1� Private ❑ Depth to Water Table Y_• ft. Character of soil to a depth of 3 feet: Sand 0 Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (if yes,date------ ----------) No ❑ New Construction: Yes ❑ No ❑ FNA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: -eP from nearest well %public sewer is available within 200 feet.) Ali ----------------------------- is No septic tank or cesspool permitted i - aterial --s""5eptieTa`nk. - Distance - / .Q__Distai c trop f undation_--/0 v - - No. of compartments------------ - - - f q P. Capacity__- G----- Size_*._! _ ._--Liquid de th_-- -- ------ ---0 Disposal Field: Distance from neares Il-_. Q Disf ce,from foundation.../0..........Distance to nearest lot line__- �_____- ----- Number of lines_ _ _..t____-__Length of each line_ ___ ____ Width of trench.- Type of filter material___ ___Depth of filter material__ ��-.Total length_.,__ ____ _____________� Q Seepage Pit: Distance to nearest well--------- from foundation--------------------Distance to nearest lot line----------------- ❑ Number of pits.-------:-------------Lining material_----------------------Size: Diameter------------------------Depth--------------------------------- Cesspool: Distance from nearest well________________DistAce from foundation--------------------Lining material------------------------------- _ ElSize. Diameter--------------------------- ----------DepAi--------------------- --------- -----------Liquid Capacity.-..-----------------------gaIs. Privy: Distance from nearest well------i----------rrO�----------------------Distance from nearest building----______________-_________--______-.--. ❑ Distance to nearest lot line------L ------------ --- --=-----: •----------------- ------••-•---•---------•----------------------------------- -------------- Remodeling and/or repairing {describe)-----------------__ ----_-----.-.-- ---__-- ------------------------------------- 11---•------.-----------•.......-------------•-------.-------••-.-.-- r" ' ""`------------i--------•--------------------••---------------:------------------------------------------------------------------ ------------- ------------------------------------- ------------------ ------------------------------- ---------------------- - -------- ----------------------------------------'----------------'---------------------------------------------------V ..._ I I hereby certify that I have prepared this application and,fihat the work will be done in accordance with San Joaquin County ordinances, S la . ;.an utas regula+io of''+he'Sari Joaquin Local Health Dis+rict. -gyp— Owner and/or Contractor (Signed) ------ { / By:----------=-----------------------------•--------------------•-- --- •----------•- --------------------•-------- (Ti+I ) . e (Plot plan;showing size cf lof, location of system in relation to wells, buildings,-etc., can be placed on reverse side): - r � FOR DEPARTMENT USE ONLY ` s q► q► APPLICATION ACCEPTED BY---. ` - _ DATE 1 ' / / REVIEWEDBY---------------------------------- - ••------------ DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED-----------------------------------------------------------------------------•-••-------------------- DATE------------------------------------------------------------- --------------------------- Alterations and/or recommendations-------------------- ----------------------•------------•----------------- •-•-_----------------•• I ------------------•------------------•----•--•---•----------•-------------•---------- --------- --------------------- ----------------------------------- ----•--------- -----------------------•-------------------------- --- ,- --------- --- - - --•- •------------------•------------------------------------••-------- -------------- --------- -- ---- - -------•-------------•-------- •-•------•---------------------------------------------------.._..------------ FINAL I NSP - - . --- ------- = Date '_ .zrZ_ 7/ ------------------------------ SAN JOAQUIN LOCAL. HEALTH DISTRICT ` 130 South American Street 300 West Oak Street 124 Sycamore Street 305 West 9th Street } Stockton,California Lodi,California Manteca,California Tracy,California Ca•9 REVI9EO 0.99 r.P.127,2"'I'll"