12448 - Laserfiche WebLink

Home Browse Search

FOR OFFIC USS: a APPLICATION FOR SANITATION PERMIT Permit No. __�=._ ..7j --- ------------ ---------t------ I ------------------------------------------------------- (Complete in Duplicate) Date Issued --------------------------------------------_______________ i This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Or 'nance No. 549. JOB ADDRESS AND _______._. ��jjyy�� ------------------- --------------•---•-••-------------- ------•-----•------------------------- %lOwners Name--_t!'vt---------- .0 — -- ----------- ------ --------- Phone----------------_------ Address... •-------------- --•- Address.----- ------- / � -- Contractor's Name-- --- 9-a---------------------`•-- ------------------------------------------- -------- Phone. �_-27 Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __:_'__ Number of bedrooms .3__. Number of baths -!/./ Lot size __ / __�, � �--_----------------------- Water - __.-_-_Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ) 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 E �New Construction: Yes to ❑ FHA/VA: Yes ❑ No ®--- TYPE -rTYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r Material_ WWjgc?'a/M_M Tank: Distance from nearest well_ -�'_____Distance from foundation._.�_____________Material_______�_�. ______ d _ 9K, No. of compartments-____._ ------------Size-- ?XS� --------Liquid depth-------fl----`-------------Capacity. 9o,0-7.0-/.. Disposal Field: Distance from nearest well�ho�_____Distance from foundation_AF__�_ ..__.Distance to nearest lot Iine.S..__..... Number of lines____3_____________________------Length of each line�� -Z7--��_-Width of trench.-r� y. _-___-_-__-___--_ Type of filter material__�_r�_4_6_&_____Depth of filter material-----J__T-----_-_Total length__- _________________________ Seepage pit: Distance to nearest well__' ---------Distance��om foundation---%Q............Distance to nearest lot line___ [fi Number of pits_------- -------Lining material____1_k.p_C.t-----Size: Dia meter___fA' ........_Depth____._.4......... -------------- Cesspool: Distance from nearest well____-------------Distance from foundation--------------------Lining material------------------------------_______. ❑ Size: Diameter--------------------------------------Depth-------•--------------------------------------------Liquid Capacity---------------------------- Privy: Distance from nearest well____----------------------------____--------_____Distance from.nearest building_____----_----------__-_-.--_____---_.___. Q: ❑ Distance to nearest lot line----------------------------------------------------------- -----------------.------------•--------•---•------------------------------- Remodeling and/or repairing (describe)=---------------------- ---------------------------------------------------------------•---_••----------•---------...----•---------------•------......... ------------•-------------------•-----••--------- ------------•------••-------- ------------------ ----------------------- -----------------•--- -.----••------------------ -------- -------------------------------------------------------------------------•-------------------------------.-------------------------.----------------.---------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------- •------•-•-----------------------•--------------------------------------•----•----------•-------•----------- - - I hereby certify that I have/prepared this application and that +he work will be done in accordance with San Joaquin County ordinances,LStafe laws, rul and reg lations of the San Joaquin Local Health District. (Signed) --------- -------- ------------------------------------ {Owner and/or Contractor) By:-- -_-- -- ------------- ----•----tTitle)------------------------------------------...--- -------------- (Pilot plan, showing size of lot, lova+on of sys+em in relation to wells, buildings, etc., can be placed on reverse side). FOR D PARTMENT USE ONLY APPLICATION ACCEPTED BY--- - -----------..............---------- DATE---/— /f'] ---------------- REVIEWEDBY--------------------------------------------- ------- -------------------------- -------------------•----------------------- DATE--------•--•----------------------------------------------- BUILDINGPERMIT ISSUED-------------------------------------------------------------—-------------------------------------- DATE..----------------------------------------------------------- Alterationsand/or recommendations:-----------------------------------------------------------------------------------------------......----------------------•---------------•------------------- --------------- - ---- C- ------------------------------------------------------------------------------------._...---------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ FINAL INSPECTION BY: - -------------------- Date �a .L --r�� SAN JOAQUIN 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 a CS-9 Rfv1sr0 H-59 F,FX 11,i1M 6-60 -