13931 - Laserfiche WebLink

Home Browse Search

FPR OFFICE USE - , A, ------------ --------- APPLICATION FOR SANITATION PERMIT Permit No. _1 __q 3j -------------------------------------------- -------- (Complete in Duplicate)�_� 7/ • Date Issued .._.__ -------------------- -This Permit Expires 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 ------ 'G�1 --------- .... Owner's Name Phone Address ----rte-- 15r' ` --- ------��7- = --•-- .... Contractor's Name ------- --------------------------------------------------- --------------------- -.•••----------•--•-------------•--._.. Installation will serve: Residence [ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/---- Number of bedrooms _AR!!!Number of baths ____ Lot size _r'4n__________________ �_ ---------- ....-.-------_ Water SuPP!Y� Publics stem El system El Private Depth to Water Table .�ft. Character of soil to a depth of 3 feet: Sand.❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ® Hardpan ❑ [' 1VV Previous Application Made: (If yes,date -------------------- ) No ❑ New Construction: Yes ® No ❑ FHA/VA: Yes ❑ No ❑ `! TYPE OF INSTALLATION AND SPECIFICATIONS: V (No septic tank or cesspool permitted if public sewer.is available within 200 feet.) Septic Tank: Distance from nearest well ---- ----- '---Distance from foundation --_---1' _.Material____ ® No. of compartments------- -__------------ Size ------ 3_.X_zt'A _. __Liquid depthCapacify ... ._ ----------- (r Disposal Field: Distance from nearest well_�7�"'_Distance from foundation.---_-"......... Distance to nearest lot line --------------- Number of lines---- .____.._�-_-----_________ Length of each line--_-.____ idth of trench_______ __-_-__-_.-___� ___ Type of filter mraterial__�Q-C4 ----- Depth of filter material ------ Z_4”"___Total length ----- _&Z _%'�_6........ Seepage Pit: Distance to nearest we€I----------------------Distance from foundation --------------------Distance to nearest lot line-__-_-----._-.-_ j� Number of pits! ----------------- --- Lining material ---------- .---------- ..Size: Diameter-------------------:.-- Depth -----------------.--------------_ Cesspool: Distance from nearest well --------------_.Distance from foundation -------------------- Lining material_... --._-_-.__------.__---------.-.-- f ❑ Size: Diameter ---------------------------- --------- De th------------------------------------Liquid Ca aci Privy: Distance from nearest well --------------------------------------------_:._Distance from nearest building -----------------------------------------. ❑ t . . -. A ----------------------- Distan�e to nearest lot line-------- --•- ----------------------------------------------------------------•--------------------------- -----• Remodeling and/or repairing (describe): --------------------------- ------------------------------------------ f ---•-•-'=------------------•------------------------------- ----•-----•-•------------------------------------•------------------------•----- s ------------------•------------------------•-------------------------•--------.....------------------------•-----------------•-•----------------------•--- -------•-•------------------------ ----------------------------------------------------------------------------------•--•---•-----••---- ------------- •---------------- ._.....----------------------------------- --------------------------- 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 J aquin Local Health District. (Signed)-- -------�--- - --- If ------------------••--------------=-------------------------------(Owner and/or Contractor) BY:---------------------------------`------------------------------------------------•-------------------------•-------------------(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 BY---- + - ------ -------------------------- DATE----- . ` ?---- -- REVIEWEDBY ------------------------------ ----•-- ----------------------------------- --------------------------------------------- DATE ------------------------------------------------------------ BUILDINGPERMIT ISSUED -------------------------------------------------------------- --------------------------------------- DATE ------------------------------------------------------------- Alterationsand/or recommendations-------------------- - - ---- - --- ._ Y -----� P\ Q- ----------------------==----------------------------------•--•---................................ - = ` = .-------------------._.. -•----•-------•------------------- --- { FINAL INSPECTION BY: ------------ --- ---Date ,---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stocktonr California Lodi, California Manteca, California Tracy, California E9-9 REVISED B-59 r.P.CD. 2M a•ao 4