13083 - Laserfiche WebLink

Home Browse Search

FOR OFF CE E: �y � f . ---- -- APPLICATION FOR SANITATION PERMIT Permit No. -------------------------------------- ... -- Qrl/ 3 ------------------------ (Complete in Duplicate) Date Issued __---------------- This Permit Expires 1 Year From Date Issued Appl41cation ion is hereby made to the San Joaquin Local Health District for a rmit to construct and install the work herein described. This is made in compliance with County Ordinance NJd� � AVE - + x 7 �l - -------------------- - JOB ADDRESS AND LOCATION..W1--1------�-- ore- C, = � ' W T Phone------------------------------------ -------Name----�> --•----��'`-=.��.c-•�r.�= ------------•-•-•------------•-------•----------�--•------•----------------------------------- Address---------_--------------------------------------------------------------------------------- �.... ---------------------•-----------• ------ Phone--------•---------. --------•---- Contractor's Name..-----� ------ •E--•-�`�--------------------•-•-----••--------------•-------- - Installation will serve: Residence [g-�fApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---7-- Number of bedrooms Number of baths _---P_ Lot size ___________________________ Water Supply: Public system ❑ Community system ❑ Private � Depth to Water Table �S. ft. 1 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 ❑ New Construction: Yes 0—No ❑ FHA/VA. Yes ❑ No e-- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ................... Septic Tank: Distance from nearest well_cS�_r-_-___Distance from foundation_-/A............Material-_.-_ ? e(_Af_bo No. of compartments ________________ � Liquid deRth___�. Capacity_I J_ Disposal .........Distance.from foundation._ -'__-._____Distance to nearest lot line__ ------------ [p Number of lines---------------- ---------------Length of each line________-_ --------Width of trench-------- S`.`!_.___ _________. Type of filter material------WB_e/S____Dopth of filter material _- --------Total length----------1�___________ Seepage Pit: Distance to nearest _..........Distance from foundation 4------------Distan*ce to nearest lot line---3-'--------- Number of pits....._:_------ -Lining material--- 'A.C_!`--- Size: Diameter____. _..---------Depth-- ,,5......__---------- Cesspool: Distance from nearest well-----------------Distance from foundation__..----------------Lining material-----------------------------._._____. ❑ Size: Diameter-------------------------------------Depth------------------------------------------ ------Liquid Capacity----------------------------gals. a —__--,Distance from nearest building Privy: Distance from nearest well------------------------------- ------- ❑ a Distance to nearest lot line------------------------------------------------ -------------••--------------------- ------------- •--------•--------------------------------- Remod ling a d/ repairin (describe): _- a' dream N�I -U}-Via.----------------- T�� ------•----------------•------------ -••----------•------- • -------- �°��} ------- (/' --- ---------------------------------------- r. i __________________________________________________________________ I hereby certify--*Sthave prepared this application and°that the work will be done in accordance with San Joaquin County ordinances, State laws, and es and'regulations of the San Joaquin Local Health District. St ned _ ---- ----------- ------------------------------------------------------------(Owner and/or Contractor) (Title} ------------------- -------- - - -- - -- --------- (Plot`*n, showing size of lot, location of syste in relation to wells, buildings, etc., can be placed on reverse side}. FOR DEPAR MENT USE ONLY APPLICATION ACCEPTED BY ------ DATE-•---- �� c �---------------------- -- ---- -------- -- ----------- - REViEWED BY ------ DATE-----------------------------------•---------------------- -------------- ------- -- ------------------ ------------------------------- --- BUILDINGPERMIT ISSUED-------------------------------------------------------------- --- DATE-----------------------------------------------------------• Alterations and/or recommendations:-------------------- --------------••---•--•-----•--..•..--•--------••-------------- --------- --------------- -7 '/ __ ..___ = l - --------------------------------------------------- -------------------- ----------------------------- _, �a FINAL INSPECTION BY: -- ---- -- 'Z ---- -- Date--------- ----- f ------------------------------•---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Streel 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California E6.9 RVV40ED 9.69 F.P.00.2M 6.60