13490 - Laserfiche WebLink

Home Browse Search

FOR OFFI S ✓ - ------------- ----------------- ----------- AP LICATION FOR SANITATION PERMIT Permit No. ...... ... ... ....�� --- ------- - -------- `f-I"'/----------- - (Complete in Duplicate) �l --This Permit Expires t Year From Date'Issued Date Issued ______ 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 Ordinanc 549. JOS ADDRESS AND L TION 37 ___j- ---------- -------- ` - .............. Owner's Nam - -- ---•- _ ---- ...... _..._ • ------- -- Phone---_------------------------- Address --_----------------- _ ....'-•'r-----'... --- -- - -------------------------------------- ---- Address..--••-------=-• =------- ------------------ ----------------K-------------- ----•-•------- '----- .. ............................................. Contractor's Name-------- --- -7----- Phones �] Installation will serve: Residence Apar ment House E❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living uni+s: ..!-.___ Number of bedroom's -2—Number of baths .../--- Lot size .----------------- Water ----.............. Water Supply: Public systemCommunity system❑ Private E] Depth to Water-Table ft. AllCharacter of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay f❑ Adobe ardpan ❑ Previous Application Made: (If yes,date____________________1 No New Construction: Yes 0 No� FHA/VA: Y s ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: . (No septic tank or cesspool permit+ed if public sewer is available within 280 feet.) epti Tar�c: Distance from nearest well-______--.___--__Distance from foundation--------------------Material------------------------------------------------- L /l�cyJ No. of compartments--------------------------Size---------------------- Liquid depth--------------------------Capacity-=--------------------- Disposal Field: Distance from neares+ well__________________Distance from foundation....................Distance to nearest lot line----------------- //J� Number of lines-----:---------------------------- Length of each line------------------=-----�-----Width of trench--------------..-------------------- Type of filter. material____________ ____________Depth of filter material-----------------------Total length_____-___---_-___--_-__-__-----__-_-___ Se pa a Pit: Distance to nearest-well'_f z->�),ff_Distance JmQ,,m foundation___/_,�D---------Distance.4o nearest lot line___-� _.__ W ' Number of pits.-__. ---------------Lining material-. $ize: Diameter______ R3------- Depth----- ------------ ,,ww Cesspool: Distance from nearest well-----_--------__'Distance from foundation--------------------Lining material__._____.____________,_______________- 1 ❑ Size: Diameter---------------------------------------Depth-------------------------------- ------Liquid Capacity----------------------------gals. Privy: . Distance from nearest well-------------------------------------------------Distance from nearest.building____________________-__-----____________- ❑ Distance to nearest lot line---------------------------------------- -------------------------- -•---- •--------------- --••-•------------------ Remodeling and/or repairing (describe ________,/'-- �.3__._.. _ C�� 1.._..._ .__. -------- - -- ------------------ . -------------- -- -s�_------- - ---- - ----- --------- -•------•--------- ------------------------------------ -----------•----• -- -----------------------------•------------------- ------- -- ----------------------------•--•----------------•----•-•----------------------------------------------- I hereby certify thatI he prepared this a n and that a work will be done in accordance with San Joaquin County ordinances, State laws, and le a gala+' ns of the San Joaquin Local Heal+ District. (Signed)----------------------- = `--- -- � '• : caner end/or Contractor) By:--------------------- = -- � = .'.(Title) ---- ----- - (Plot plan, showing.size of lot, location of sys i ation t wells, buildings,. , can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- - - - --------------------------------------------- ,------------- ---------------- REVIEWED BY----------------------•----------- ------ ' -------- - -------------- - -----• --------- ------- --••------------ DATE---- -•---------------------------------------------------- SUILDENG PERMIT ISSUED------------- -------°----------------------------6 DATE er !ons and/or recommendations: --------- --------------------. - *!1--'-'- mo, , = - • ,-�•-- =-= ---r��--j� yk--I . --/-- -- --" ---:' tf,c --: . - r---------- --------------------------------------- `-------------------------------------- = e ---------------•-•--- -------•------------------------------------------•-•---•-----=--------------------------------------------.-..._...---------------------------------- • t . FINAL "INSPECTION' BY .. : _C -• .- -_----------------------------- Date----q '• -JS---... --.(0....1---- ---------- ------------------------------ 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 ES-9 REVISED B-s9 r.P.CD.2M s•613 "1