13146 - Laserfiche WebLink

Home Browse Search

...............1 ------- ---r-,--------_�_- APPLICATION FOR SANITATION PERMIT Permit No. ...!' ----------------------------- --------------------------- (Complete in Duplicate} s -.--------- This Permit Expires 1 Year From Date Issued Date Issued ..._.� .. _l_ Application is hereby made to the San Joaquin Local Heal+h District for a permit to construct and install the work herein described, This application is made in compliance with County Ordinance No. 5t JOB ADDRESS AND LOCATION............. .. - ..__ ;,�-. __ __`'_ _ �_ _ -- --- -------------------------••---------- -------------------------------------------- Owner's Name d/r f / * Phone Address---------__914---X ---------- Contractor's Name - /?,,— `115;11-----------------------------------------------•--- ---_---------------------- Phone---- ----- - --- ---------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: ._.- Number of bedrooms ..-.. Number of baths..--,O-'-.. Lot size --- Water Supply: Public system Community system F '00Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe B—Hardpan ❑ Previous Application Made: (If yes,date----.---------------) No P- New Construction: Yes ❑ No 20"'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-------------------_Material------------------------------------------------- .Y0jf//ff No. of compartments--------------------------Size---------------------------- ---Liquid depth--------------------------Capacity-----------•--•----_- Disposal Field: Distance from nearest well-----------------Distance from foundation....................Distance to nearest lot line__..__.........._ IVOU xf Number of lines---------------•---------------_---Lengfh of each line------------------------------Width of french-------------------------._..------ Type of filter material-------------------------Depth of filter material-------------------.---Total length------------------------------------------- Seepage Pit: Distance to nearest well---_-.�----------Distance from foundation__--1, Distance to nearest lot line---.L -------- L Number of pits-_---../....-.___--Lining material. a �� •---Size: Diameter-_�..��---------Depth- _'--------------- Cesspool: Distance from nearest well-----------------Distance from foundation.-------------------Lining material-------_-_- .------..-..._.-..._..- ❑ Size: Diameter--------------------------------------Depth--------------------- -----------------------------Liquid Capacity------------------.-----...gals. (� Privy: Distance from nearest well------------------------------------------------- from nearest building--------.-__------._....____-__.....__---- �I ❑ Distance to nearest lot line----- -------------------P------------ - Remodeling and/or repairing (describe: � 1 --------------------------•-------•----------------•--•-• ---------- ------------------------------------•----------------------------------------••-------•----------------------------------------------------I------------------------------------r----------------------------------- -----------------------------•---------------------------...--------------•-----------------------•----------•-----------------------------------------------------•--------••------------------------------------------------ I hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regu tions of the San Joaquin cal Health District. (Signed)---------- = _./L 1 PJ' .. .. �iL/'------------------------------------------- Gwn ffii [ er�fvr Contractor] --------•------------------------------------------- �7�tf --------------------------------------[Title}- .C� -- ------------ By: (Plot plan, showing size of lot, location of em in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---C'__ _�� ........................... DATE_..._��-__I(a__--�t'-1- _ REVIEWEDBY------------------------------------ ---------------------------------------------------------------------------------------- DATE------------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE.----------------------- / --- p r ................ ---�------•------------------- Alterations and or recommendations:-_l sI-.---im- -------------------------------------------------- --------------------------------- -----------------------------------•--------------------------------•------------------••----....------------------------------•----•--- FINAL INSPECTION BY:.....(--'......Qa---�------------- --------------------- Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Weal Oak Street 124 Sycamore Street 205 West 9th Street Stocktonr California Lodi,California Manteca,California Tracy,California ce-9 Rrvisuo a-59 r.P.co.aM 6.60