13104 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. 3 Lo lin Duplicate) (Complete Date Issued. I L3 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. t ADDRESS AND 0 ------------------------------------------ ----------- *�." - jr� LOCATI --------------- 8� P Phone------ -- -------- -------------- -------------- ------ -- Owner's 5_x --- -- ------------------- Name----, --- ---- e------ -- -------- --------- -_�--- ------ ---- --- -- ------ Address-- -- -- ----- ----- --- • Contractor's Name------__ -- -------I- ------------- ------------------------------------ --------------------------------------------------- ----------- Phone--------------------- -- - ------------Installation will serve: Residence F-1 Apartment House El Commercial [] Trailer Court [3 M el E]. Other 1� ----------------- Number of living units: -------- Number of bedrooms -------- Number of baths --- ---- Lot SIZE Wafer Supply: Public system E] Community system El Private F] Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand [] Gravel [I Sandy Loam 0 Clay Loam X Clay �( Adobe[] Hardpan 0 1 W Previous Application Made: Yes 0 No �( New Construction: Yes No E] FHA/VA: Yes F] No TYPE OF INSTALLATION AND SPECIFICATIONS: I .%III (No septic tank or'cesspool permitted if public poilala �Ics Wei IS-4%-_ 1,61ewithin 200 fe trial- '? ' Septic Tank: Distance from near�sf wellT is aric I f f d ion____/P-------- -1cl y-------- ------------- 6,p c -----Liquid depth-_---- No. of compartments------- Disposal Field: Distance from nearest well----/.-Distance from foundation---- ..Astance to nearest lot line__--------------- -Lengfk of each line--- Of f ------/-------- lo� rench ----------------- Number of lines------- - -_ I y Type of filter material -,5-1,:--H-- &Depth'lof filter material-----I-g-------------Total length------1-5-0------------------------ .1 Seepag.e Pit: Distance to nearest well----------------------Distance from foundation---_---------------Distance to nearest lot line_-____-___-___-_ ❑ ine----------------- F1Number of pits----------------------Lining material---------- ------------Size: Diameter----------=------------.Depth-------------=----------- ------- 11 --- - Cesspool: Distance from nearest well_____________ Distance from foundation------------------ -.Lining material----- -- -------------------------- Size: Diame#er_ _- -_---------------------- l ------------- -------Deptl� -- ----------------- ------------------------------- Liquid Capacitygas.. Privy- Distance from nearest well------------------------ -I.1---------------------Distance from nearest building------ ---------------------------------- ❑ uilding----------------------------------------- 0 Distance to nearest lot line----------------------- ------------------------------------------------------------------------------------------------------------------ Remodeling and./or repairing (describe}:------------------- ---------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------I-------I-------------_------------------------------------------------------------------------------------------ ----------------------------------------I-------------------------------- ---------------------------------11 -------------_--------------_------------:------------------------------------------------------------------ 11 ----------------------- ----------------------------------------------------------------------- -------------- ----- - - - ------ --- -- - - -------- ------- ------ - ---------I hereby certify-- that I--have-prepared.-i-his-application and.C�that the work will be done in accordance with San Joaquin Courify ordinances,:St:fe aws, and rules and regulations of the San Joaquin Local Health District. ---------- -------------------------(Owner and/or Contractor] ISigni. ---------(Title)----------------------------------------------- ----- ---------- Ofio" wells --- system i- e�aio, buildings, etc., can be placed on reverse side). (Plotplan, showing size of lot, location of------- By:--------(W- ----------- ---- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- BY------- -------------- --------------- ---------i#---- ------ ------------------------------ DATE--- ------------ REVIEWED BY------------------------ DATE: ------------------ - - BUILDING PERMIT ISSUED---------------------------- ------ DATE----- ---------------------------- ------ Alterations and/or recommendations:---------------- ------ -- ----- -------------------------------I--------------------------------------------------------------------------------- --------------------------------------------------------------------------- -----------------------------1�------------------------------------------------------------------------------------------------------------------ il - ----------------------------------------------------------------- ------------------------------------------------------------------------------------ ------ ------- i--•---------•-------••----------------------------- --------------------------I--------------I------ - ----------I--------------------------------------------------------------------------------------------- ---- ------------------------------------------------------------------------------------------------------------- --------- ---------------------------- - --- ----1 6 -----------J-�---Z -- --------------- - -----------•-------------- -----------I-------------- ---------------- ---------------------------------------------------- FINAL INSPECTION BY:----------------- - Date------- ---- ----- --- - - SAN JOAAQQUIN 11_0�.� CAL HEALTH DISTRICT` 130 South American Street 300 West Oak Street i 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California eS-9-21A Pevisecs 1.57 F.P.CO.