13437 - Laserfiche WebLink

Home Browse Search

FOR OFFICf.,,SE: = � Permit No. _ APPLICATION FOR SANITATI(oi-4 PE RM{T --- -f -r---------- (Complete in Duplicate) Date Issued -------------------------------- - - ___________________ 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. 2<2' This application is made in compliance with County Ordinance No. 549. i JOB ADDRESS AND LOCATION_t...' ...... �.t?- sem- -------------•---��-----,----------------------------- Owner's Name •-•----- J, 4.. Phone Address---- -•-------------- pp _ ----------•- -----•-------- -------------------------• --------•--------------••---•- •---... Contractor's Name---------- -----s:�___7--— Phone---------------------------•------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court [f'Motel ❑ Other ❑ Number of living units: Number of bedrooms ______ Number of baths .____..- Lot size ___T- °----_--••-------- ----••----------•- Water Supply: Public system ❑ Community system ❑ Private UK'Depth to Water Table -,4-a ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (if yes,clate--------------------) No g3""New Construction: Yes KNo ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS. (No septic tank or cesspool permitted if public sewer is available within.200.feet.) Septi Tank: Distance from nearest well-----------------Distance from foundation___________________.Material_____-_-______________.__-______-__--.__________- �� Liquid depth--••---------------- ----Ca acit No. of compartments------------------------- Size-------------------------------- p y...-------•---�-•---- Disp 1 Field: Distance from nearest well Distance from foundation___ !'____-_-___Distance to nearest lot line__yv._______. Number of lines------ ----------------- -----Length of each line-----__l43 �_- Width of trench.----•- -`------------------ `U (/��,�►j�/y�(j� Type of fii#er material--�.�-e-__�_-____Depth of filter material__--rjr-_�__-__-__Total length_-_____ ______________________ $ Distance to nearest well-,I Aa_-_.____ Distance f. foundation__-. .____.__.Distance to nearest lot line___ _______ material _�_._C-1f_--Size: Diameter___- .-8`___-__ R � Number of pits______-------- - ___Lining mater' � --..Depth--------��---•-------- Cesspool: Distance from nearest well-----------------Distance from foundation..-----------------.Lining material------------------------------..8 ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------Liquid Capacity_.--------•---------••----g15. . Privy: Distance from nearest well-----------------r__---____._______--_.______-__Distance from nearest building-_-____---______________--______---____. Distance to nearest lot line------------------------------------------------------- •---------------------- E Remodeling and/or repairing (describe)---------------------------- --------------------------- •--•-------------------------•-------------------------.--------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------ --------------•--------------------------------------------------•-----------------------------------•------ •---------------•- ------------ ---------- -- --------------------------p-•----------------- I herebycertifythat I have re aced t asp I* ation and'that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regul tions the Vanjoquin Local Health District. Si ned _ [Owner and/or Contractor) --- •-------- -------- --------------------------------------------- •---------------- -- -------- Title-------- --------------------- -------------- - -------------- By:-------------------------•------- - - ---- - •---------- l )(Plot plan, showing size of lot, location system in relatells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY J f elf APPLICATION ACCEPTED B -- u-��_---- - -- ' � L- nom- DATE =--_time- REVIEWED BY------------------------- - `--------- --------------------- -------------------------------------- DATE ---- ---------------- BUILDING PERMIT ISSUED---,�- --=------------------- - -----------------------------------•--- DATE Alterations _1__ and/or recommendations:-_ __ - _.__ __l :- ------ i � ��' 1-��' --•••________________________________ � ---•---•-------- -------------------------------------------------- -------- --------•--------------------------------- _------- ------------------ --------------------------------- -----------------------------I--------------------------------- ------------------- ------•---------- --------•------ -------------- ----------------- ---------------------------------- 1��A"- --------------- Date_-. _� - /-�-� ----------------------- FINAL INSPECTION BY:_S_�;�r_.__-�'. -- - / SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodir California Manteca,California Tracy,California l ES-9 REV{5EC 9.59 F.F.CO.2M 6-66