12524 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ---- -""----__----------------/44 .__ APPLICATION FOR SANITATION PERMIT Permit No. _•_ .....J�_-....... � ------------- ------------------------------------------- (Complete in Duplicate) -------------------- I -This Permit Expires 1 Year From Date Issued Date issued ___-..-.� -G 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 Ordinance No. 549. a - JOB ADDRESS AND LOCA ION.._ ,. ' ,. .-------------------------------------------------------------------------►:-- ----------------------- � e r y Owner's Name---- - ---r------ � '�_�---------•---•-•----•-----••-•-------•-- --•-------------- •-------------•---------------------------- Phone...-------�---------------•-------- Address =/fry ----• ' Contractor's Name--- `' j- -----------------------------------••••---------------------------------- Phone---•---.-------------- i---------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __l_ Number of bedrooms J--- Number of baths -/--- Lot size `7Z? :7-• -------------------------------- Water Supply: Public system e--c"ommunity system E]— Private ❑ Depth to Water Table -'fy It. Character of soil to'a depth of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam ❑ Clay ❑ Adobe Hardpan t] : Previous Application Made: [If yes,date--------------------] Noew Construction: Yes QNo �FHA/VA: Yes ❑ No _TYPE OF INSTALI_AT10N r AND SPECIFICATIONS: i } of permitted.if public sewer is available within 200 feet.) [No septic tank or-cesspo Ta Distance'�from nearest we9ll_ •Distance from foundation_-._le----.---.Matvial---�--�- __ - ------------- Septic No. of compartments_�_'tL �_ .. 'Size_ __ Z_--•__-Liquid de th_-.$( Ca acit ;.� p! ------------- Disposal ------------ P Y Dis osal Field: Distance from nearest well__�L�--- -Distance from�foundatio � "'`�`�'' p -- .- - ".��.--_-_--.--.Distancer'.to nearest lot line- ------------- Number of lines____ _ Length of each lin e------t��_____-_......Width of trench.- ._-__- - � Type of filter material1 Depth of filter material_. �� -__.-Total length__--_ --__-------------------------- �!u Seepage Pit: Distance to nearest well_--------------------;Distance from.foundation_-_._-_-`___._.___..Distance to nearest lot line----------------- El Number of pits--------:-------------Lining material--------.------- -Size: Diameter----------------------"Depth------.-------------------------- Cesspool: -.-_------- ---__-Cesspool: Distance from nearest well-----------------Distance from foundation.-------------------Lining material------------------------------------El . Size: Diameter-------- ---------------------------De th--•-----_--------- v___,:=' --_---------Liquid Capacity gals. 7 Privy: Distance from nearest well---------------------------------------------------Distance from nearest building-.---------------.-.-----___-------------. ❑ Distance to nearest,lot line--------- ----------•--------------- -------•---------------------------------•-•---------------------------------------------•----------- `J 1 emodeling and/or repairing (describe):--------- - � = f. ----------------------------- ----------------------- A4,: _0A ------------------------------------�------------ •--------• -- ------ I hereby certify that I have prepared this-application and that the work wil�be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) 1i. = 4746-vI- ----------------[herr Contractor] -- ---------- --------- -------- By:----•-•------•------------------- ----------------- - -- ---- s -----------------------------(Title)---4CIf It --_< ------- - ------------- (Plot plan, showing size of lot, location of syst to relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY� _- . _ - -- - . -------------------------------- DATE------ 1----�--f'------------------------- REVIEWED BY --- ..... --- DATE --------------••------- BUILDING PERMIT ISSUED--------------------` --/ ' ----------- -••• -••-------------- DATE - -------------------- -------------------- -- --------------------- ---•--•-------- Alterations and/or recommendations:-----":.--.------------------ _.-- - - = n ------- ------------ (. _. L - �d-✓ 1._ .tea - �'�t1cJ� = / ------------------- __ --------- - -- - --------- --- // a— - ----- ------------------- ------- -- - -- f n''-• _- 401.Z!-- -- � --------------------- FINAL ��G FIN L INSPECTION BY:: _-- --- Date----- f/"""" .�-- - ------ a------ SAN JOAQUIN LOCAL HEALTH,DISTRICT k l 130 South American Street 300 West Oak Street ) , -rt ,y 124 Sycamoie S!eet 205 Wast 91h Street Stockton,California Lodi,California Manteca,California ` Tracy,California . E9-9 REVIBEO 9-59 F.P.CO.2m 6.60