12751 - Laserfiche WebLink

Home Browse Search

FOR OFFICE SE: _-_-.___.__._.______.------------------------------ APPLICATION FOR SANITATION PERMIT Permit No. ........:::�.../ -------------`------------ Date Issued __. ------------------------- (Complete in Duplicate) / ------------------- 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_c.F-�1.6-- �� --- ------ d --------------------------------------------�--+----- Owner's Name----- �-� ,r-- -L�t�ICR�.iY1�l ---------------�-------- --------------------------------------• ---------------- Phone__ _s�0V_fd-_..... Address--------------------� __� ! - .7_--------------------....------------------------------------------- p Contractors Name.-•----------------------..-- -![. -!1.�_---s-1----+---sr-kc—�--------------------------- Installation will serve: Residence 2� Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __Number of bedrooms __ __.- Number of baths --- r --- Lot size --•� -•-----,}�.---I��"Q----------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Tablt_ Character of soil to a depth of-3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe, , Hardpan ❑ Previous Application Made: (If yes,date____________________) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: , (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Distance from nearest well----------------- from foundation---------------------Material-------.----_-_----.________________._--_______- No. of compartments------ ---------•---------Size--------------------------------Liquid depth--------------------------Capacity----------------------- D�p sa ' Distance from nearest well_Afi�n, Distance from foundation'.. Q ______Distance to nearest lot p Number of lines_____ ____ -.Length of each line__. __ "p�LT , g �_gpf Width of trench • -! Type of filter material___ __ p g __i_ _-_ --Depth th of filter ma#erial____1d_.,,____---_Total length �_________________ See a Distance to nearest well----------------------Distance from foundation__________;_`-------Distance to nearest lot line................. %i Number of pits---------------------Lining material-------------.------ .___Size: Diameter----•-------------------Depth-------_------------i�:---------- Cesspool: Distance from nearest well-----------------Distance from foundation-------------- _.Luning material__ -:_._W.__.._____--_-________.__. ❑ Size: Diameter--------------------------------------Depth------------------- -•--•--•-------------- #------Liquid Capacity---------------------------gals. Privy: Distance from nearest well------------------------------------------------- from nearest building_______-______________________________._ ❑ Distance to nearest lot line-------------------------------------------- --•------•------- .... Remodeling and/or repairing (describe):----------- - - • ---•---------•---------------•-----•-------------------------------- -- - -- -- --- - ------------------•-------•----------------------------------------•-••--••------------ ------------------------- ----------/------------------•----- . ------------------------------------ ------------------•----•------•--------------------------------------- ----------------------------------------------------------------------------------------------------------------- I hereby certify that 1 have prepared this application and that the work,will be done in accordance with San Joaquin County ordinances, State laws, and rules and regul tions of the San Joaquin al Health District. (Signed)____R- _-- f r > ',a 1 _e�[-• N ----- ( Contractor) r By:.......------••------- --- ....(Title)------------------------------------------------ ------------- (Plot plan, showing size of lot, location of system in relation to w uil etc can be placed on reverse side). f FOR Df PA TME T USE ONLY �- APPLICATION ACCEPTED BY---- -- ---------------•--- DATE--- ;r-- /_ REVIEWEDBY--------------------------------------------------- ---------------------------•-------------------------------•-------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED--------------------------------------------------------------–-------------------------------...-.-. DATE....--------------------------------------------------------- Alter tionsand/or recommendations------------------------------------------------------------------------------------------------•---•-------••---------------••----------•-------------- ---•-------------------------------•- ------ ----------- -- --- ---- . - -------- - -- ----------- ----- -- ------ ---- FINAL INSPECTION BY:_ -- -- - -- - ---- - -------- Date---�v�s-��l---------------------•------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT' 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California �s - E6•4 REVISED B-59 P.P.Go.2M 6.6a