12917 - Laserfiche WebLink

Home Browse Search

FOR OFF ---- USF. --- Ja �"�" ------� � �' ( �q ---------------��%--------------- ' APPLICATION FOR SANITATION 'r,,K, ,T Permit No. ...�._...._ .. •... ---------- -- (Complete in Duplicate) 17 / Date Issued .---•----.•-•-:--..l�-/ ---------------------_-_______--.--.-----..-- `'-- This Permit Expires Z Year From Date Issued `3 3 Leo --p/ Application is hereby made to the San Joaquin Local Health District for a permit to construct and instzfll the work herein described. This application is made in compliance with County Ordinance No. 549. v eLS-- 7 -7 a JOB ADDRESS .AND LOCATION- e _r"- �, ami-- p� ,f' .t - - -•- r � iL. ----- Phone-- clrr.6 Owner's Name---. _ t, , ---- Address.......R_ ------ �< ------- - ------------------------------------------------------ -------------------•- Contractor's Name--- f Installation will serve: Residence ❑ Apartment House ❑ Ctmmercialj-® T ail'er Court ❑ Motel ❑ Other �� Number of living units: .---___- Number of bedrooms _------. Number of baths .--,--__ Lot size ------------------------------------------------------------ Water Supply: Public system ❑ Community system ❑ Privato'IKpepth,to-Water Table - -.,ft, "p Character of soil to a depth of 3 feet: Sand [3 Gravel E] Sandy Loam E] Clay Loam 2 Clay F]Adobe❑ Hardpan ❑ .� Previous Application Made: (If yes,date--------------------f No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ r TYPE OF INSTALLATION AND SPECIFICATIONS: .. C (No septic tank or cesspool permitted I if.public sewer is;available within 200 feet.) � ��C*Sfo C. o,yG Septic Tank: Distance from nearest well--,,5_2g--- Di's�ance from foundation--._ "`�""�MateriaL- " ' --_- �, No. of compartments--.---`' -._______ 'Size- _K_ X --`_.......Liquid depth-----4 -----.Capacity.-., Disposal Field: Distance from nearest well d'Tr:�Distarice from foundation.._5'`�--.--.Distance to nearest lot line................. Number of lines- � Lp of each line------7-S`--------------Width of trench---2¢"-------------- --_ yp g of filter material 4-`�E" Total. lbngth-----1676..........-------------- --'� -. Len th ViltT pe of filterlmatenai..-yT�L� ' """ De tht, Seep;ZNage P t:: Distance to nearest well ____ _"---_-- etfrom'*ff:ounn-a ion--------------------Distance to nearest lot line._--------..--.-_ .4, ,, �x', ` •t ----____Linin material Distant `"�❑ � ._. .p -�� iC�--------------Size: Diameter---•--•------ --------Depth-----------------"--------------- Number of its---. - :---- �'tCesspool:, 30\h t''Distance.,fiom'nearest well---------------. Distance from foundation! -tining mater,ial------------- ------------------------ r.r `, ❑ Sizb: Diameter------------ -------------------- -)Depth-- _ Liqu! pa y- ------..--------------•--.gals. Privy: Distance,from nearest well----------------_-----...-------------------_..Distance from nearest building_--.-.-.----_.-----_----____--_.__-------. ❑ -- ------------------------------- Distance'.to nearest lot line----------------'------------------------- -------------•-•-•----------------------•------------•--------- t I- Remodeling and/or repairing (describe)----------------------------- t ---------------"---------"-----"------"-----------------------•----------------•------------------------------ -------------------•-----------------------•--------- -----------.-------------------------- ------------------- lii -------------------------------------------------------•------------------------------------------- ------------=-----------•----,------------------------------ ------- --•------------=---------------------- -----------------------------------------------------------•------------------I------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San'Joaquin_Loca1,Health,Dist rict; (Signed)--- -- --- ----- -'------------------------------------------ ----•--------- (Owner and/or Contractor) I B - - -----~ I„ ---(rifle)---------- --- ---- . _ --------------- (Plot plan, sho ing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED "BY------- ---------------------------------------------------------------------- DATE------ •� �� --�--f------ --------------- - REVIEWEDBY-----------..--...--.. -------------- ------------•----=----------------------------=--------------------- DATE----------------------------------------------------------- I BUILDING PERMIT ISSUED ----------------------- --------------------- = - = DATE Alterations and/or recommendations:-------------------------- a ; ------------------------ ------------------------------------------------ ---------------------------- ----------------------------------------------------------......-------------------------------------------------------- ----------- s ------------------------------------------------•-------------------- --- ---------- ------------------------------------------------------------ FINAL = l FINAL INSPECTION BY----_---- .. r--�'t-C'------------------ Date_ ------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street c Stockton,California ;I' Lodi,California Manteca,California Tracy,California E6-9 REVISED 0-69 r.P.CO.ZM 61613 }