13522 - Laserfiche WebLink

Home Browse Search

�rricE USE: .- �=' �M APPLICATION FOR SANITATION PERMIT F^gfmit 4o. ._t..3.. - �— (Complete in Duplicate This Permit_ Expires.1 Year From Date Issued Date Issued _______________________ I Application is hereby madeto the San Joaquin Local Healfh District fora permit to construct and install the work herein described. This application is made in compliance with County Ordinanc o. 549. JOB ADDRESS AND CA ION -- ------------=-- -----------------------------------------=•---------------•-•--•---•------- Owner's Name--------- ----•-------- -------------------------------------------------------------------- Phone...................___--•---•---- Address----------- .'� -- --------------------• •••. -------------------------------- ------ _ ~� one Contractors Name Ph -----•--------------------------- Installation will serve: Residence ❑ iI Apartment House;❑ Commercial ❑ Trailer Court ❑ Moto El Otherp , t Number of living units' ,, -_ Number of bedrooms ._ Number of baths` Lot size _____.________________ oe Ar Water Supply: Public systemommunity system ❑ Private ❑ Depth to Water Table ft. Character of soil to a"depth�M of 3 feet: Sand ❑ Gravel ❑ " Sandy~.Loam ❑, Clay Loam ❑. Clay ❑ Adobe ardpan ❑ Previous Application Made: pp• li(If yes,date____________________) No ❑ New Construction: Yes ❑ Na ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION LAND SPECIEICATIONS: __ •,, ! (No septic tank or cesspool permitted if public sewer is availabie'within 200�feet.)1 Septic Ta Distance from nearest well-------^_.__ I Dion---l ---------Mat� ial---�6 d( -_-•-- rtmnts__--- ____________ Si - esr No. ofm � uid de t __ `_ Capacity--� 42------ Disposal Field: Distance�'from nearest well--- -----------Distance from foundation-_A`r�______-Distance to nearest lot line. -_... Number.!of lines------ f___ .-____ _Length of each line _�`___.Width of trench_ _______�__________________ Type of3filter material Depth of filter material--- ----Total length.___�$1_ ______________________ Seepage Pit. Distance.to nearest well-----:'�""-------Distance r fou da ion---.fp---------.Distance to nearest lot Iine�_�.___._ � Numberof pits--' -----____--Lining material - -- -- ize: Diameter. ��____ -Depth---.r2e _.�..-•---_____. Cesspool: Distance from nearest wall-----------------Distan a fro undation.._._._.______:_---.Lining material-------------------------------- !i ____________ - Liquid Capacity gals. ❑ Size: Diameter--------------------------------------De th__ Privy: Distant I�from nedbst well_______________________________ _- Distance from nearest building.____.___-----_--________________-___-.._. ❑ Distance('fo nea rest"lot line_._.-___-------------------- 4 - :--_`___ ---- Q�; 1 4 Remodeling and/or repairing:(describe: - -- = ------------------------------------. ----------------- ---••----------------•-------•------ 'II€ -------•---•---------------- --------------------------- -------------------- -------------------�M�`-------------------- - - --- ----- -------------------•-------------- �� E -------------------------------------------------------- ------- ---•- -- 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, an "rules and regal tions of the San Joaquin Local Health District:' -- c Si ned 1 I 9 ,1---------- ---- - ------------- -- > '�------------ -�°_-" ---- -----------------------• ------------------ -------------- �r Contractor) By:- _--- ----- --------------------------- Title -- - -- - ------ - ( i. (Plot plan, showing size of I d locatian of m in relation to.wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE"ONLY REVIEWED BY uBY < � --. Z DATE f -.C-•.S---�-.�4'-- ------- ------------ APPLICATION ACCEPTEDI b'--- ----•--%------------------ -------•-------------------- DATE----------- BUILDING - -------------------------- BUILDING PERMIT ISSUED-6------------------------------------------------------------------------------------------------ DATE-------•---- Alterations and/ori nd/or rme dattons:--------- -- -_- -^--- �--- j--------- _ = .-�-�� _s... s ---------- s �t- --------- ---------------------- - ---------------- ----------- -----._._.-------�-------------------------- ------------------------ -----==--------------------------------•--------------:-----------------------------.---------------•---------••------- ------------------- --------------- -- ---t-------------------------------------------------- ---- FINAL INSPECTION BY: Date--------- ��,P SAN '0 11A LOCAL HEALTH DISTRICT '�"1'30 Soulli American Street• 300 Wee!Oak 5lreef• 124'5 Sycamore Street y 205 West 9th Street Stockton,California Lodi,California ' Manteca,California Tracy,California ES-9 REVISED 6.69 F.F.r P.2M 6.60