14327 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: -� �- APPLICATION Ff7R SANITATION 'PERMIT Permit No. - -- --- - ---- ---------------------------------- -- - a._�. // ---------------------------------------------- -------- (Complete in Duplicate) 4� --.--- This Permit Ex ires f; Year From Date Issued Date Issued ___- Application is hereby made to the San `Joaquin Local Health District for a permit to construct and inst91I the work herein described. This application is made in compliance''with County Ordinance No. 549. JOB ADDRE5 AND LOC TION.-�IJ---�--7--_ l�-aa---®-29_10------•- -------------------------------•------------------------------------------------•--._......---- Owner's Nam ------••. -----------• ---LC.�ti9..-- ------------------------------------------- Phone .................................... Address. ---"-LC. .. -------------------------------------------------------------------------------------------------------•---------- -------------.------------_--------------- Contractor's Name----'-------- ---------- ------ --------_..................... Phone----------------------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Other ❑ Number of living units: !_G-- Number of bedrooms Jo_. Number of baths ._/.1)_ Lot size ...... .................................. Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table _: 7 ft. Character of soil to a depth of 3 feet:'I Sand ❑ Gravel ❑ Sandy loam ❑ Clay Loam ❑ Clay ❑ Adobe[Hardpan ❑ Previous Application Made: (If yes,date--------------------) No K New Construction: Yes [E' No ❑ FHA/VA: Yes ❑ No ®� E TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) SFpt' Tan R Distance from nearest well_________________Distance from foundation--------------------Material_________._____.______ ----.--..-_.-.--..--_--_-_. No. of compartments-------------------------_Size-------- -----------------Liquid de #h--------------------------Ca acitY•--••---•---•...--•--• Dispoal t Distance from nearest well_________________Distance from foundation___r___._______-___.Distance to nearest lot line-__........._.... Number of lines_____I---------------------------Length of each__1line___ ____-_..-. Width of trench....*2...y.``.........._........ Type of filter material-_-_- , . - .____. _Depth of filter material ______-Total length______ ____________________ Y 1 Seep gd Distance to nearest well----------------------Distance from foundation__..._________-_-.-.Distance to nearest lot line----------------- l Number of pits---------------------Lining material-----------------------Size: Diameter.......................Depth................................. Cesspool: Distance from nearest well_________________Distance from foundation--- ---------------.Lining material...____.____.______------._..-_.._._. ❑ Size: Diameter------- -----------------------------Depth---------------------------•------------------------Liquid Capacity---------------------------- r Privy: Distance from nearest well-------------------------------------------------Distance from nearest building____________________-___-----_.__._____._. l,V ❑ Distance to nearest lot line------------------------------------------------------------------------------•------•--------------------•---•------------------------------- -- --------------------------------------•----------------------•.....-•----....---•---•...------.......--- Remodeling and/or repairing (describe):______.___________________________ ___________ t ---•--------••----------------•-------.._...--•-------------------(---•-----------•--••----------------------•------------------•----••-------•------------------------------•-•----------------•----•------•----------------- 1 I hereby certify that I have prepared this ap ication and that the work will be done in accordance with San Joaquin County ordinances, tate laws, and rules and regulation f e San Joaquin Local Health District. (Signed)------------------------------------ ................I -------- ---- -------------- ---------------------------------------------------------------------(Owner and/or Contractorl , By:........................•------•....----•---••-•....... --- --- --- --------------------------------------------------------(rtle)---------------------------------------------------------------- �p [Plot plan, showing size of lot, location o sys min relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ) APPLICATION ACCEPTED BY-------------------------------------------------------------------------- -------- DATE------- ?----- ------ REVIEWEDBY----------- -----•-•-------........ --------- -----------------------------•------------------------------------------------- DATE------------------------------------------------------- .... I BUILDINGPERMIT ISSUED_..__..-•---------------------------------------------------- ............................... DATE------------------------------------------------------------- Alterations and/or recommendafions:-------------------------------------------------------------------------------------------------------------------------------.-------- ••-----•------------- ----•--•-•----••---------•-------------------------------------------------------------------------------- --------------•-----------•------------------------------------------•-------....-•------------------•---------- -- ------------------ ----•------....,.__. .......... ......... ----•-------------------------------------- --------- .._ .....----•--•----- ---------------------------------------- ------------ ----•---------------------------- -------- ------- ......-----•-------------------------------- FINAL INSPECTION BY:-------------- - ------ -- --------- Date.... -- •---- ..---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 144 Sycamore Street 405 West 9th Street Stockton,California Lodi,California Monteca,California Tracy,California E6 9 REVISED 5-59 2M 5-61 ASE.AS j