13036 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. ....l..J .�7:.� (Complete in Duplicate) This Permit Expires I Year From Date Issued Date Issued Dl�-- X30�-D`] 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. JOB ADDRESS AND LOCATION - --------- `�•1c s', l � �' ------ -- �j -------------------------------------- -- ---.-. ..-- Owner's Name------e-qZ---- -(... --------------------------- - ------ PhonAlt-------15-Ne 21 /fes , Address------------ = /,;• ------- ------------ Contractor's Name ----------------------- --------------- Phone-------------------------------- - Installation will serve: Residence IV Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -1----- Number of bedrooms _3___ Number of baths _L.._ Lot size __ --------------------------- Water Supply: Public system ❑ Community system ❑ Private J�a Depth to Water Table - a- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam W Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No N New Construction: YesZ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1 Septic Tank: Distance from nearest wellDistan4�fro fou�nd.+ation__I_V_........Material-_ _____-----..:_________..___.____-- +�,,, No. of compartments Size__._..7�t_.. _ _-5J__._. Liquid de th.____ ---_---- _ LJ p q p. --------Ca acit /�� Disposal Field: Distance from nearest well_,V�+----- Distance from foundation.-I --.---.Distance to nearest lot line_S'.___.._.. N Number of lines____1�r__ __ __ ____ _________Length of each line---Fq-------------------Width of trench___-v r__-_.----._---------- Z Type of filter materia G _____-Depth of filter material_.i f__'___________Total length.._ ,_�f 0_ ________________________ Seepage Pit: Distance to nearest well-------------_--------Distance from foundation___________________Distance to nearest lot line_____._________._ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth_------------------------------ Cesspool: Distance from nearest well-----------------Distance from foundation_.-----------------.Lining material-_______--.-_____-_____-____--__- ❑ Size: Diameter-------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well____--------------------------------------------Distance from nearest building-------------------_____________.._--.._. 0 Distance to nearest lot lire----------------------------------------------------------------------- ---------------------------------------------------------------------- Remodeling and/or repairing (describe):-------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ----- ---------- -------------------------------- ----------------- --------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules a regulations of the San Joaquin Local Health District. Si ned � '-- _-- -- ,/ Owner and/or( 9 }-- ----- ==4----- ------------ ------ •-- - ------------------ ------ ---- ----------------------------------------------------------------------{ / 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___�'f�`_-W//--_________ - --- --- ----- -- ------------------- REVIEWEDBY----------------------------------------------------- -----------------------------------------------------------------------_ DATE------------------------------------ BUILDINGPERMIT ISSUED__..-------------------------- ------------------------------------------------------------------ DATE------------------------------------------------------------- Alterations and/op recommendations.t------------ - ----------------------- ------- ------X� ---------- ------ f 3 �;� < , --------------------- •---------- --- ---------- - -------------------•----------------------------•------------------------- ----------------------- e _________________________________________________________________________________.-_--.-_-__-----_----_-_-_._---___-_.-______-___._.___________.-.-______---.-_.-_.--------------------------------------- _-.--_-___._--._ --------------------------------___----------------------------------------_------------___-----------------------------------------------------------------------------__------_---------_______----------------------------- FINAL INSPECTION BY:- le.,44- Date Nf---- -�/J- - --- Z - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 8-'59 F.P.Ca.