12588 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: S Z-' ---------------- YAPPLICATION FOR SANITATION PERMIT Permit No.--------------•---------------------- --------- (Complete in Duplicate) Date Issued _. --- I This Permit Expires 1 Year From Date Issued I 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_._--01-5-0.__ Owner's Name- ----------------------------------- --------- Phone--------------------- Address--------•- Ak1:1Q-4-----------•----------------------------•------------------------------------------------------------------•------•----------•-----------------•----•-•---- Contractor s Name____S;�r } .d + - T V --- Phone.-- `f_. a 7 la -------- -------1- ---------------------------------•----------•---------- --------------------.._...----•---- Installation will serve: Residence ©' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel 0 Other ❑ Number of living units: .-_!____ Number of bedrooms _'___ Number of baths -_J___ Lot size __.`'�pxf------------------------------------- Water Supply: Public system 0- 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 ID' Hardpan ❑ Previous Application Made: (If yes,date____________________) No [)-- New Construction: Yes tj'No ❑ FHA/VA: Yes ❑ No,© 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_,5?u orf_____Distance from foundation-----f!?__/..__.-.Materiaf---_ �iJr?_�_-________________ 0� No. of compartments-------2—-------------Size-----3�4�f— - ____.___Liquid depth____1_ ----------------Capacity__R- aZ, [- 1 Disposal Field: Distance from nearest well------_.___._Distance from foundation2tn_---_________y_.Distance to nearest lot'line--5--/______--- Number of lines-----------------X�_-J--------Length of each line---.__---2_ 90---.Width of trench.--- .&•.-.._..__.------.-- Type of filter material-"XIo '(__-______Depth of filter material_.6 .f _._____..__.Total length_______ _•`_----____-__•__ u .. _ Seepage Pit: Distance to nearest well____ ____._______Distance from #oundationl[�__----------Distance to nearest lot line----------------- Number _ ________Number of p;is.--/----------------Lining material-- --Size: Diameter-------O� -------Depth-.----�-`l©------.--- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material________._______.__.___---__________-. ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity-------------------------.._gals. Privy: Distance from nearest well------------------------------------------------- from nearest building--------------._-...._._____---._._-_____. ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe)=--------------------------- ------------------------------------------------------------------------------------------------------------------------- -----•-------------------------------------------------------------------------------------- -- j-- -- --------------•--------------- ------•------•----- ---------------------------------•-------------•---------------- ----------------------------------------------------------------------------------------------------- ----------=---------- - - ------------------------------------------------- -------• --------------------- I hereby certify that I have prepared this-application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)-------------------------- ••----------------------------- ------ -----,------ --------------------------------------------------- ---- ------{Owner and/or Contractor) By:---------------------------------•----------( ------=C....... -----------------------------------------------------(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 ON APPLICATION ACCEPTED BY-- ---.-- - "Z' r . ------------- ---------------- DATE------�--------- � �------�- - 4 � - - - - - ___-_________. REVIEWED BY-------------------------------------------------- - - -------------------- ------- -------------------._.. DATE------------------------------------------------------------ BUILDING PERMIT ISSUED--••--•-----•------------------------------------------------- --------------------------------------- DATE..-•----•-••--•---•----------------------------•---._....- - Alterations and/or recommendations:.------------=------------------------------------------------=------------------------------------------------------------.---------------------------------- ------- ----- ------------------------- ------ - Z .- . ----- c ------------------------------------------ FINAL INSPECTION BY:. Caa` = .- Date----� (P - -------•---•------------------•--- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES-9 REVISED 0.59 F.P.DD.$M 6-60