13773 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: t z k_U. APPLICAT{ON FnR SANITATION PERMIT Permit No. ..��--�,•--`�-� -- ----------------------------- ------_ ---------- (Complete in Du Duplicate) -----�---- -•----- -- P � Date Issued •---...-----•-•'--- J This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health Dis#ric# for a permit to construct and install the work herein destriloed. This application is made in compliance with County Ordinance No. 549. LOCATION.-IN-17; � ............................................................... JOB ADDRESS AND ` •-----••--- Phone-------------------------------- Owner's Name...... G _Q`_ -- --------------------------•-------- -------------------- •---------- ---------------...................... ... -----•--••--------•-•••-----•-----r . ---------------------• Address...-------e!. .0 ------ ` lPhone---••--•--------•-------•---------- IContractor's Name.---- -----------------3 S---- ----------•--•-------•--------- - ----Motel Other ❑ Installation will serve: Residence [I Apartment House ❑ Commercial ❑ Trailer Court 29 Number of living units: __4.__ Number of bedrooms .__1___ Number of baths J-___ Lot size '--------•-- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table Cla- ft' Hardpan C]Character of soil to a depth of 3 feet: Sand E3 Gravel Sandy Loam❑ Clay Loam ❑ y ❑ Adobe[ Previous Application Made: (if yes,date--------------------) No e New Construction: Yes [rNo (3 FHA/VA: Yes ❑ No 2�' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within X00 feet.) Septic Tank: Distance from nearest wellt...Distance from founddation_1.Q_______-------Material___�...---.------......-•••••......... No. of compartments__________ _____ Size. - x`Sx�/ Liquid depth---�/ / -------- -CaPacitY v p "- ---•-Distance from foundation./$_____________Distance to nearest Disposal Field: Distance from nearest we lot line_.['...______.. Number of lines._..----- -------------------Length of each line--------4...•.....----.Width of trench__...__.., ._!�!.---.•----- Type of filler materia.. .- - _ - ----De th of filter material____.Jr------.--._Total length-----------------�q--------------- O o Distance to nearest lot line....___..__..__._ Seepage Pit: Distance to nearest well-------____.___---___Distance from foundation_______________•___. \ ❑ Number of pits-------------- ------Lining material-----------------------Size: Diameter-----------------------Depth--------------------••----------- \ Cesspool: Distance from nearest well-----------------Distance from foundation....----------------Lining material-______________________________cls �1 ❑ Size: Diameter------------.-------------------------Depth----------------------------------------------------Liquid Capacity-------------------- -----g Privy: Distance from nearest well--------------------------------------- ---------Distance 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 end regulafions fh 5an Joaquin Local Health District. Si`ned -------------------------------------------- (Owner and/or Contractor) ( 9 -------- ------------------- ---=--------------- (rifle) ------------ --- -� gY� -• --••----- -- (01bt plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY ---•----------•----- DA71= "" �, ..��...__....= _ - ------------------------------------------- . ----•- DATE REVIEWEDBY..-----•--------------------------------- ------------------------------------------------ - ----- DATE BUILDING PERMIT 155UED--------•------------------------------•-----------•--._._...__.------• - -••------------------ Alterafions and/or recommendations:..___.------------------------------•----- ------- •--- -----•--•---•------------ --•-----------------•------•---- ....----•-•--••--- •-•---•------------• -- i -�'�'---�-�--�---�-',e`-.1------------ ------------•--._._.._._. FINAL INSPECTION BY:.. 1 ------------------------ Date---- I? SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street - Stockton,California Lodi,California Manteca,california Tracyr Californla ES 9 REVIS£5 6-59 RM 5-61 A71_AS