13561 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: - --------------- <r-c_ ------------------ _____._____--- ._______-_ -............. -- -- - �_ f t --- APPLICATION, FOR,SANITATION PERMIT Permit Nd .�3 S_......_.. - - - --------- ------------------- --- ------ - (Complete in Duplicate) ¢ z. a .___:__- Whis"Permit Expires 1 Year From�Date'lssued -�' Date Issued _!.._._._ __ _� Application is hereby made to the San Joaquin Local Htaalfh District for a permit to construct d install the work herein described. This application is made in compliance with County Ordinance No. 549. ,x" 3 E _ -� ON i JOB ADDRESS AND LOCATIONI_Q.�L/__4__.___4cAl_K-D--- /j_ --__-lf £---_- -•_-_-_-_-_-•_ Owner's Name-U-/----,4ZjA1c,_h.F".L: ----------•---------€•-•-----------------------------------------------------------------------.- Phone.........--------------------_--- Address-------- •-----------•---•--_--- Address-------- --------------• E------------•-- -----------------------------------------------------------------------•-----•----------------------------- Contractor's Name------------------------ _--__--_-_. Installation will serve: Residence M Apartment House ❑ .. Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ _ Number of living units: __�.___ Number of bedrooms ��__—Number of bathsLot size __75�}____..�..3.�________________________________ Water Supply: Public system �) Community system ❑ Private ❑ Depthrto Water Table ---------ft.'" Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe® Hardpan W i Previous Application Made: (if yes,dote--------------------} No ❑ New Construction: Yes•[ •. No ❑ FHA/VA: Yes ❑ No [I �- TYPE OF INSTALLATION AND SPECIFICATIONS: c J (No septic tank or cesspool permitted if,,public sewer is available within 200 feet.) c� U, Septic Tank: Distance from nearest well__ _____i.__Distance from foundation__________________Materia ______'_._______._.___._________.._________ �] No, of compartments_..__ —_______________Sixe- :�__---___Liquid depth___ _...._____._Capacity. DO Disposal Field: Distance from nearest well ___._.":--------Distance from foundation./±�_-".____-.Distance to nearest lot line__-�__'--.____. Number of lines------ ------ - __.__ ____ g _ / �' _____.:Lenth of each line_��`-- ---��-�----�dth of trench.:-")--/----------------------- ' _ Type of filter material-,0__�A------_-Depth4of"hi r material_.fr_//--------Total length____.__Q_._�------------________ Seepage Pit: Distance to nearest-well_______________¢'-__Distance from fonation_L_�-_____6...._..Distance to nearest lot line----------------- ❑ Number of pits------ --------------Lining material--------- Diameter.-----------------------Depth--_�_.__..-.--.---------------- Cesspool: Distance from nearest-well---------------- Distance-from foundation"'_.____._______..Lining material___ --------------I................... ❑ Size: Diameter------------------------------------- Depth---------+ ------ -•--------;----------=----Liquid Capacity-----------------------------gals. Privy: Distance from nearest well--------------__ .__-------_-_----.___.____._-__Distance.from nearest building_:,___.___.____________--__________.____. Distance to nearest lot Ione =--- ------------------------- Remodeling and/or repairing:.(describe)------ �. f -- -------------------- = ------ --- = --------- ---------------- ------- -••• -----------------•------------------ --------------------------•---------------------------- ----------------- ---------- -- t--- r -------------------------------------------- ----•------------------•-•-•---------------------------------- -------. ----------------------------------------•----•-•-----------•-----------•--•-------------------- 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 and regulations of the San Joaquin Local Health District. r k f f H = - ' _-Owner and/or Contractor 1 ----------------------------- %BY ----'------ ---------------------- ___(Tiifle)__ (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- ----2--&-•�---�/--------------- REVIEWEDBY------•---------------_--------------•-= =------------- ' ..... ... DATE ••--•--------------------------------------------- BUILDING ------••-----------• •--- - BUILDING PERMIT ISSUED--------------`----¢__._" s - -------------•-= — ------------------------- DATE.: ' Alterations and/or recommendations:-= _:.___�-== R------ - -----------------------=-----------------------•------=----------•--------------------.------=--------=--------- ---------------•----------------•------------------------------------------------ -----------------------,------------- ---------------_..: ---------------•-----------• ............... -----•----•-----------------------•---------------------------------------- ----------------------------=-•--•-------------------------------------•-----------------•----------------- -•-----------•----• -• ---------•--- --------------------------- --• --------- - - ---------- ----- ------ ---------------------------------•--•-•---•------- ••-------.---- ----------------I——--------------------•- -------------•- vr' :_'_ ' 'w"r".t .. `Date �y�• ------------------------------------------------- SAN &V FINAL INSPECTION BY:_.��----- --=- ------- -- - -- ------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 245 West 9th street Stockton,California Lodi,California Manteca,California Tracy,California ES-9 REVISED S•59 r.P.r0.2-6-60 i(