12758 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: 1 -7 'K ,2, 7's- ---------------------- --------------------- -----. APPLICATION FOR SANITATION PERM! Permit No. -- ....................--------- ---------------------------------------------- P P A —1 's -ko --------------- (Complete in Duplicate) Date Issued --------------•---••--- _-- This Permit Expires 1 Year From Date Issue ------------------------------- 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.--- -� _�� ?. Ak. ---ff f Phone..l.---.f�. ------------------- . � - -. Owners Name---.------ ----- -•- GL�r1 tLl..• Address----------------------- ----- :��fid-<=-----------•------------•-------------•-------------•---------- --------- ....-•-•--••... Contractor's Name----------------- ------••-------•---•----- -------------------------------------------•---------- .. Phone.......--•--•-•---------•----..... Installation will serve: Residence Apartment Houser[I Commercial E] Trailer Court ❑ Motel ❑ Other ❑ f � - ----�---•�--ate------------•---••------ i•Number of living units: ---f-- Number of bedrooms ---R- Number of baths -------- Lot size --------- Water�p Supply: --------WaterSupply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand E] Gravel El Sandy Loam ❑ Clay Loam El Clay ❑ Adobe❑ Hardpan El i Previous Application Made: (if yes,date--------------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ i TYPE OF INSTALLATION AND SPECIFICATIONS: - T(No septic tank or cesspool permitted_if.pub!ic.sewer is available within 200 feet.) Se •ank: Distance from nearest wellA46�-Distance from foundation-------------------.Material--------_---------..---•-----------.-_.--------. No of compartments' Size------------ --------------- --Liquid depth Capacity I /f D� Field: Distance from nearest well--eeA� -.Distance from foundation ----- ----------Distance to nearest lot line---- --_..._ Number of lines----------------- - Length of each line-------v_. -------.------Width of trench--:-----� ?.-•-•----- k -.--:_:-Total .len th--------- ype of filter material---- or- --Depth of filter material--_.-�•-- g -------------- T Seepage Pit: Distance to nearest 61 -Distance om foundation----`j*--.__---.Di tante to nearest lot'in ----.-- ....... .�{� Number of pits-------- ---------Lining material-/%-t?�--�....Size: Diameter-//Y---9 --- Pik,. -_�. _.- -r___•.------=_' 'i fig-tc-,--ir-- I Cesspool: Distance from nearest well-----------------Distance from foundation----- -----------------Liining Cater a gals. ❑ ---------- Distance from nearest well------------------------------------------------Distance f-- ne q P +Y ---- Size: Diameter---- ------------- ---- - ---- --- Depth-- Privya � 'from nearest building------------------------------------------/ ------------------------- ... ❑ Distance to nearesf 16t line---------- ----------- t .. Remodeling-and/or repairing (describe}:------------------- --------------------- -----•'- f -----------•--------------------------------- --------- ---------------------------------s ------- ---------------------------------- ---------------------------------------m---- ----- .------•------•------- --- ------------------------ 3 - --------- • --- - _ ! hereby certify that I have prepared this application and thatthe work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. �� l (Owner and/or Contractor) � ----- ------------- --=- - ----•- ------•---------------------------- - By:---------------------------------- -----------••--•:------------------------------------ •-------------- .---------(Title...-------•------------------------------------ (Plot plan, showing size of lot;location of system in relation to wells, buildings, etc., can be FOR on reverse side]. FOR DEPARTMENT USE ONLY --------------------- APPLICATION ACCEPTED BY ----------- ---------------- ------------------ --- DATE------- --�V- i REVIEWED BY- ------•---------------•------------ -------.---: ------------------- ----------•-------•----------------...-----• ----- DATE---------------- -------- -------.-----•------- BUILDINGPERMIT ISSUED-------------------: -----------------------------------••• DATE------------------------------- --------------------------- Alterations and/or recommendations_____________________�- - •------- ---•------------------------------••--------•------- ------- • - - ------------•------•-•-- --------- •------ -------- . ----------------------------------------------------- - ----- FINAL INSPECTION BY;---- --- --------------- Date--------'-- ' -• --�. _-�.�:-----------•-•------•------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,Cakifornia Manteca,California Tracy,California E13.9 REVISED 13-59 r.P•00.2M 6-60