12991 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: -� ------------------------ --- - ---------------- -------- -----------------------_-______-__..-_--------------.- APPLICATION FOR SANITATION- PERM{Tj„ Permit No. ..1. __I__-L_._ -------------------------------- ----------------------- (Complete in Duplicate) k 3/ - This Permit Expires I Year From Date Issued Date Issued .._._.___'S_/A l Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This.applicatiori,.is made:in compliance with County Ordinance No. 544. � _�1 ---------------__---------- JOB ADDRESS ANQ.�OCAT N___-_ ' ___.. _ _______ r___I�L Phone' Owner's Name--- - `----- t L—---- Address -- Address------------------------------------------------ �` 1 _.._.� -, _ '_-C---- -- ---- ------>-----)WA-11-- ------. ------------ Contractor's Name-------------------------------------• ---------------- - ------------_✓` _ #tone Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Court [] Motel ❑ Other ❑ >Number of living units: _;�tmurfify ber of bedrooms__ _ Number of baths y.. Lot size ___ __ ________________________________________ Water Supply: Public system system ❑ Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam e Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date__.- ,:_.--._.-__,__.] No ❑ New Construction:, Yes ❑ No ❑ FHA/VA: Yes E] 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`we11:'M-Q__ Distance frfo nd ton__r ----------_.Ma'terial------------------------------------- X _.--__-________Capacity__.. _------- _No. of compartments.__-_ 7—- Size___ / - _Liquid depth isfance to nearest lot line___b_ n•r-.., Disposal F�Id: Distance from nearest well�p d.__._.Distance from.foundation_/__� ' Number-of lines---, ength of each line-----�4P------is-----.Width of trench.---� �- ------------ Type of filter mate ria l___-�[___--- _________ epth of filter material-----Z_�__-_._Total length_________.._._.. Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line__._____.__.-_--- ❑ Number of-pits--`--------------------Lining material-----------------------Size: Diameter-------------.----------Depth-------_----------•-------------- Cesspool: Distance from nearest well_________________Distance from foundation_,_-______-__.__.__.Lining material-------------------------------- ❑ Size: Diameter--------------------------------------Depth--------- ------------------------------------------Liquid Capacity--------- -------gals. Privy: Distance from nearest well----- _------------------------------------------Distance from nearest building--------._--.,_______________.__.__._._. ❑ Distance to nearest lot line-- -=---------------•----------------------•------------------------------ ------------------------------•---------------- ; Remodeling and/or repairing (describe):----------------- ---- ------- -- - -------•---•-----------------------------------------•--• ---------------------------------------------------- ___________________________•__-________________________________-._____-----_-•________.___._________:R�____________________-__-__--_______•_____.___________________.._-._-_-______..__,._.___----.___.-___--_----___--____ \ r _____________________»___________________-_--__________________..____.__.---•----____._-------_______________._......._......_________ __________.._._______________.____..,.--_-_______.____.________..._-. _____________________._____._____....._____________...__._______________________..__._ r � e ---------_-----------------------___________________________________________________________________________________-________________________._.._. . I hereby tif' that I have prepared this application and fihatrthe'work will lie done in accordance with San Joaquin County ordinances, t e I s, and a re tions of the San Joaquin Local Health District. I _ (Signed)---- ------------------------------------ --`----- - ---------------------------- ---(Owner and/or Contractor] " Title (Plot plan, showing size of lot, location of system in`,relation to wells, buildings, etc., can be placed on reverse side). FR.D, TM T USE LY1 } I APPLICATION ACCEPTED BY------ =--- ------ = DATE _ REVIEWED BY - ----------"--------------------------------- DATE BUILDING PERMIT 155UEQ - }.. .�....., = DATE. ------------ -----------------........... -- - ---------------------------------- Alterations-and/or recommendations:----------:--"--------------- - ---------------------__-----------------------------------------------_______________1.__._____-___-.______._________._.-..-..--_______.____-____-_-_____.____________________________--.__________-----_-........._._.______ 1 ..........._----------------------------------------------_---------------.----------------------------------------------------------------------------------------------.---------------------------------------------------- k t t FINAL INSPECTION BY:--------- Date . ----------------- ---------------------------- i. SAN JOAQUIN LOCAL*HEALTH DISTRICT 130 South American Street 300 West Oak Street P-%J Z 124 5yca pts Street 205 West 9th Street S Stockton,California Lodi,California Manteca,California Tracy,California 99-9 REVISED D-59 F.P.CD,2M 6-60