13562 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: - � f ----- ---------------��_ v4 j ._____ APPLICATION FOR SANITATION PERMIT Permit No. ._ b_-- 7�� --------------------- (Complete in Duplicate) /2 _ _. ,... Date Issued _______________..__.__-.-----------------_________.__. Thts Permit'Ex ires 1 Year From 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 Ordinance No. 549• JOB ADDRESS AND LOCATION_�-Q_ - --'- ._ .-_.& 4!t__E-.G.:.----I .T�---_?--------------------------------------------- Owner's Name- - J IL1 C ----• --------•---.........------------------ ------- --•--- Phone---_-------•-•-----------•----•--- Address.... U------xp ------------------------------------- --------------------•-------------------------------------------------------------•........... Contractor's Name------------------------ ~~ --- Phone)__I.Y.Y -_ Installs#ion will serve. Residence (0 Apartment House E] Commercial ❑ 'Trailer Court ❑ Motel ❑ Other ❑ + a f S y Number of living units: __�---_ Number of bedrooms -_3___ Number of baths ._.(___ Lot size ._-___-'�____-_-- _X. Water Supply: Public system (0 Community system 0 Private ❑" Depth to Water Table ___-__-. ft. t Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe® Hardpan T] Previous Application Made: (If yes,date;-.__________--------) No ❑ New Construction: Yes Z 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-----------------Distance from foundation_h4-------------Material___/ _._---_.-- ❑ No'of compartments____Af_'.............Size_-. _(� `-S.___:__.Liquid depth------U-2r---------__-iCapacity_i�s__ Disposal Field: -'Distance from nearest welJ .-___._..-----Distance from foundation_LG�-------'.0 Distance to nearest lot line__------.. �7 ��rJ S"�3� I�dth of trench---- ------ -- ------------- ' ❑ Number of lines_-_-._____�________.__:______Length of each line_'____�___--_„_:.-___. Type of filter. material+' !1_G%C -------Depth of filter material___ ______ ____Total length____A_ _Q__r___________________ Seepage Pit: Distance to nearest,well-----7`"""'_---=__Distance from foundation--------------_.-..Distance to nearest lot line ❑ line______ ______ dumber of pits material Diameter----------------------.Depth Cesspool: Distance from nearest well--------------------Distance from foundation ________________.Lining material-------.-_____._________ ElSize: Diameter--------`----------------------------Depth------•------------- ------------------------=--._Liquid Capacify-------------=----------- gals. f Privy: Distance from nearest well---------------------------------- __________'._Distance from nearest building__________-_-__-___________--..__-------. ❑ Distance to nearest lot line--:-- ----------=---------------------------- --------------------------------------•----------------------------------=------------=--------- Remodeling and/or repairing {descnbe#:-+ # ----------------••--------------------------------------------------------------------------•-----••---- . -----------•- r t ----------------'--'-------------------------------------------------------------------------------------------------------------------------------------•------------- ---------------------------------------.---------------- ----------------------------.--------------•---------•--------r--;. �:.:'----------------------------'•-•-------------------•'----------------•-------•-•-•---------------------------------------------------------------- - I ----------------------------'----------------------------- -- - - - - --' -•-•---••-----_..-.....•--------------------•-------•-------------`--•------------'-'•-----------------------••--'----.-_- ------------- - 1 hereby certify that Fhave prepared this'app4ication 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. ' Si ned ._-: -•-- •----- -- - `- -T----------------- ---------------(Owner and/or Contractor) BY� = = - ------------------- s' ---------------------------------------------------`:_ -----=................(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 ONLY APPLICATION ACCEPTED D BYr - -------- DATE 2 `- / REVIEWEDBY = #-------------•-----------------------------------------DATE-------•----•---------------------•-----------'•------------ BUILDINGPERMIT ISSUED---------------------------'------------------ - = ------ DATE------------------------------------------------------------- Alterations and/or recommendations:_-'_z-______._-_----- ------'_ ---- q r r j s i ---=----- ----- ---------------------------------------------•--•---------------------•-•---•---•-----.-.--------------------•--••--------••----- ---•----------------•--------------•----•------------------.._.-------------- ----------. -•--------------- ------------- FINAL INSPECTION BY:.._ 1 �� --�---------- Date L--�� (`3 / r 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 REV19EO 13.99 F.P.CC,ZM 6-ba