13564 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: /w/ "=------ - s Permit No. y APPLICATION FOR SANITATION PERMIT-------------- _____ (Complete in Duplicate) --------------------------------------. _ Date. Issued ----r__--: ---..----------------------_.._.___------____.______.__ !This'Permit Ex ices 1 Year'From'Date Iasued�''"- 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./ d" JOB ADDRESS AND ``LOCATION_j_P_f �{�-----...... _r�c---- 2------------------------- •-•------------- Owner's Name .. = -- =s------ -------------------- =--- "P one ...- - Address...... y-------�------S_-r-------------------------------------------- -------------------------------------------------------- -------------------------------------------------------------------- Contractor's Name ----------•---•--•-•------ Phone.j-/.o-:--�__73�-- --•-----•-----------•--------------- t Installation will serve: Residerice Ig Apartment Houserr❑ `Commercial ElTrailer Court ❑ Motel E]Other 13 t Number of living units: __--i_. Number of bedrooms -3___ Number of baths __1... Lot size ____-'--�___-- _.ls __________________________ Y ® A 4 -4- -- Water Supply: Publics stem Community system ❑ Private.L Depth to Water Table_____-- ft. } Character of sail to a depth of 3 feet: Sand C] Gravel ❑ Sandy Loam El Clay Loamr❑ Clay C] Adobe [� Hardpan 0 Previous Application Made: [If yes date_______---,--_.----) No ❑ New Construction: Yes 21 No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) d� Septic Tank: Distance from nearest well ----------------- Distance from foundation_/ -.d------------ Materiai___PS_ X12 wo -0 U-�-- No. of compartments: ---- 0___i�-----------Size__, '_9_ ------Liquid depth ------ W__)----- ------- -Capacity-. ----- Disposal Field: Distance from nearest well --.._:_-_____---Distance from founrdafion2 ----------------- Dist ace to nearest lot line --- 5 ---._---- Wi f Number of lines __-__4_ - Length of each line__ i th of trench.__________ ________________ =--7 . r Type of filter materiaL_r�d'__��__------ Depth of filter ma+eriaL___�_�_.____._Tota) length__=___�_�%________________________ Distance to Distance' from foundation Distance to nearest lot line__.__. --- .------- Seepage Pit: nearest well__ -------------------- -------------------- ❑ Number of pits -----=--`------------- Lining material ----------.--•--------- Size. Diameter ---- -------------------- Depth_:------------------•----------- i Cesspool: Distance from nearest well______ -__.____-Distance from foundation -------------------- .Lining material ------- r ---------------------------- _ C❑ Size: Diameter-------- -----------------------------Depth_:..':--------------------------------------- ---- Liquid Capacity..-------------------- -----gals. Privy: Distance from nearest well --------------------------------------- ___._.._Distance from nearest' building .____-------_---_______________-______._. ❑ Distance to nearest lot line ------ ------------------------ ----------------------- ...... .------------------- }----------- ------------------------------------ ------------- Remodelingand/or repairing [describe): --------------------------- --------•--------------••---------------------------------•---------------------•--------------= =-------------- -------------------------------- -----------••---------------•-•------------------------------•------------------------------------------- . : -:... ' - _.: 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. t I _vr/ � �. v - - -- ___. Owner and/or .Contractor i (Signed)---------------- `-ter t------- --- _ ( / By:------------------------------------------------- `-----------------------------,---------=-------------------------•-----------------(Title)---------------------------------------------- r --------------- (Plot plan, showing size of lot, location of system in relation to wells, buildin�gs,,�etc._, cart, be placed on reverse side). tj FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---------ems r -------- -------------•----------- DATE-----------= -------- '=--%----------- REVIEWED $Y 7-------------•------------------------ DATE BUILDING PERMIT ISSUED-----------------------------------------------:----------------------------- E----------------------- DATE --------------------------------------- ----------- .--------- Alterations and/or recommendations: ----- -_________________�_ --------------------------------------------------••--------------------------------------- ----•----------:- _-_ -: - -----------------------•--••------------------------•------------------------------------------------------------------------:-------------- -------------------------------------------------------------------------------- s F -------------------------------------------•--------•----------------------------I --------------------=--------•------------------------------------------------------------------------------------.. --------------------------------------------------------- --- FINAL INSPECTION BY:.. -.-1-2_--- ---------- ---- �---- -- ----- Date_`_/�------- ------- ----------------------------- 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 9-59 F.P.=D. 3M