13682 - Laserfiche WebLink

Home Browse Search

Nv�v, ��-CJJC ✓! ___ _ co 7 - f APPLICATION FOR SANITATION PERMIT �. Permit No. —.0��l�:. - d l /A t -------------------- (Complete in Duplicate) .r �7/ This Permit Expires 11 Year From Date Issued Date Issued ........t.. �.f 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 Ordinamce� .$4 . JOB ADDRESS A D LOCATION �....'i%�. ��.,�7� Address Air...--- Owner's Name . . Phone....__....IS V31rif...I Contractor's Name--•-- t y Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ... ... Number of bedrooms -3.. Number of baths __/.. Lot size :a Water Supply: Public system jT--c-ommunity system ❑ Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand Loam E] Clay Loam ❑ Clay E] Adobe[�ardpan [3Previous Application Made: (If yes,date____________________) No New Construction: Yes ErNo ❑ FHA/VA: Yes ❑ No @3-- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) C Septic Tank: Distance from nearest welYhs£ ___ Distance from foundation_ _._.__.___. f__ Material...... .........................d....-........ Er No. of compartments_.__._.. _____________size._.___ t- - .- _ Liquid depth__.___ _ . ----------- �" aCapacity.... .. Disposal Field: Distance from nearest welle7ZQ'4._Distance from foundation...X..............Distance to nearest lot line-_J........... ( � Number of lines.............. -------------Length of each line. Q_ _~4�7�idth of french_____. Type of filter material......1�g6k------Depth of filter material--- --------------Total length--------T.1171------- -�r_....__ Seepage Pit: Distance to near VW __. ---- I_!j' 'f-�________Distance om fou ation__ .0---____.Distance to nearest lot line_________ 091, _ Number of pits.. Lining materi �_ ____. ze: Diameter ---------Depth_______.___ Cesspool: Distance from nearest well---- ---- ---Dista fro ndation--------------------Lining material------------------------- ❑ Size: Diameter-------------------- ----------Depth---------------------------------------------------Liquid Capacity------_-----------------•-gals. Privy: Distance from nearest well_________________________________________ _______Distance from nearest building___..._.___________-.-----____.________._. ❑ Distance to nearest lot line-----------•-------------------------------------------------------------•-------------•------------ Remodelingand/ rep firing (d�ecri I`�-- _ ---- --------------------------------------------------•-----------•------------•-••-------------•----...---•------...----••--•--•--• -•-------------•-...•..... a .......----------•-----------------------------------------------------------------.•---.------------------------•---------•---••------------•--••-•----- ---- 1 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 end regulations f the San Joaquin Local Health District. (Signed)-------------------------------------------------- -------- -- ------------- ----------------------------------------------------------------------------(Owner and/or Contractor) ay---------------•-- -_-------------- --- •-------•--- -------------------------------------------------------(Title)--------------------------------------------------------.------- (Plot plan, showing size of lot, loco ioin r anon to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------•---------------------------------------------------------- , DATE...---------1 REVIEWEDBY------------------------------------------------------------------------------------------------••-•------------------------- DATE BUILDING PERMIT ISSUED. - ....•-----------------------------� DATE-----------------------------•-•------- Alterations and/or recommendations:._J_-Aq-4� • ;-�- '... -::- - ------------------------------------------------------ --•---.... --------- ---------------._....-------------------- --------------------------------- .-------•-- -• ------- --•--- FINAL INSPECTION _J� ------J -�� Date---------------- �.�.----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wast Oak Street 124 Sycamore Stmt 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E6 9 REVISED 8-59 2M 5.61 ATLAS