12196 - Laserfiche WebLink

Home Browse Search

r FOR OFFICE USE: -------- -- _ � Permit No. ---•�'�=1.� , _ APPLICATION FOR SANITATION PERMIT --------- (Complete in Duplicate) Date Issued .__ f -�'� r This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Healfh 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 LOCATI .........Z-�-- .. r r ----•-•- -•-----------------•---- y��[-c�' l��4 Phone Owners Name---- --- -- •-•------ i -- , Address----------------------- ' Contractor's Name___---�y�•�'--f-�j�---- - f - � --'- ----------------------- Phone-------------------------. Commercial Trailer Court ❑ Motel ❑ Other ❑ J�! Installation will serve: Reside ce A artmen# House ❑ ❑ +c/ ,r Number of living units: _.____ ber of bedrooms _�mber of baths _ .__.. Lot size _______ ___________ I Water Supply: Public syste Community system ❑ Private ❑ Depth to Water Table _ eft. Gravel Sand Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Character of soil to a depth of 3 eet: Sand ❑ ❑ Y No ❑ Previous Application Made: (if yes,date.___.._-_.-_,_.__---) Nog„ New Construction: Yes ❑ No� FHA/VA: Yes ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I-Sol 'c To Distance from nearest well-----------------Distance from foundatison__----------------Material_______________---.-------------------------- L -1 No. of compartments--------------- Size----- -----•---------- Liquid depth--•---------------------- Capacity � _--i�_..__.Dls#ante #o nearest lot line__.__ _._ field: Distance from nearest well-f .6J_._Distance from foundation___. Width of trench____.___ • - �--- Number of lines-------; ----------Length of each line___;_ __ =` Type of filter material_ Depth of filter material---/-jf.---- ----Total length--------Z�57 ,-----------•--- Seepage Pit: Distance to nearest well_1`i011 -----Distance from foundation__ .(-`-.Distance to nearest lot line____./-_a_._ g aterial__- m.G[_---.Size: Diameter---;7— its__ Cesspool: Distance frm nearest well------------------ from foundation__------------------Lining material.--_____.---------------------------- \ Number of ___ ---------------Lininm I ❑ Size: Diameter--------------------------------------- -Depth_-------------------•- ------ --- - - -------------Liquid CapacitY----------•-----------------gals. Priv Distance from nearest wO--------------------------------------- Distance from nearest building________________________________________. V ❑ �_ Distance to nearest lot line ---------- --------------------- ---------- ---------------••------------• ------------------•------•---------- V... Remodeling and/or repairing (doscrib ---- ------ ---- --- ------------------ •----• -- --- --------------I---- ----•----- --------------------------------------------- ----- -------- �L - --- --- -------- 1 hereby ce fy t I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta I s;and les and relatVions of the an Jaaqui Local He District. - ___ Contractor) (Signed)_ -_ -------------•----- ------ ------------(Title)-------------------------------- ---------- ------------------ (Plot plan, showing size of lot, location of system in relatio o wells, building s, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY -')rE- , == DATE b 0 APPLICATION ACCEPTED BY---- ------ DATE------------------------------------------------------------ REVIEWEDBY-------- --------------------- --------------------------------------------------------------------- BUILDING PERMIT ISSUED--------------- ---------- DATE Alterations and/or recommendation :_____ ..__.. , . -IL!T-------. ---- `j -- -----� 9 - `-- �- ---------------------- ----------------------- ------------ ------------------------ -- - .....-_... . —Date . ----------- ----- -- FINAL INSPECTION BY.-4____.�--=------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 sycamore Street F 205 West 9th street Stockton,California Lodi,California Manteca,California Tracy,California ES-9 REVISED B-59 F.P.GO.2M 6.60 1