13528 - Laserfiche WebLink

Home Browse Search

FOROFFICE USE: w - ----------------------------------------- ------ -------•------------------------------------------------- APPLICATION FOR SANITATION PERMIT r Permit No. ..........9�........ •_ -------W----------- --------------- ------------------ (Complete in Duplicate) w� --------------------------- •-- ----------------- - This Permit Expires 1 Year From Date Issued 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----5.7 313-------of---. . --� J �L ti Owner's Name_� z C - --- -Phone--•t� •''•--. 7 i Address-- - z ._. .._ ,��i �/` - �V ?-- Contractor's Name-- t C -i 2-r1�-'--hrrL &W-------------------------------------------------------------------- Phone................................... T Installation will serve: Residencex `Apa--4ment House ❑ -Commercial' ❑,- Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ----L Number of bedrooms ---� Number of baths ---(---- Lot size ..._... .................. �................. Water Supply:—Public system E] Comrnuriity system ® Private'❑ Depth to Wates Table _ - ft. T - - 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 RT] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well------ from foundation I _ �....---.Material--�`__Risi±y_ ..No. of compartments.-----:-'� -.___---...Size. Liquid depth------ r------ Ca _: � 7y Disposal Field: Distance from nearest well___Distance from foundation----L0...r Distance to nearest lot line.____ 1?_� Number of lines_____-_-__-____________________Length of each line..+'______-�-Width of french....2_�................�__ Type of filter material._.7Z0e__/C-------Depth of filter material___.__1-__________Total length... ......_5KO-...... Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line---------- ....... ❑ Number of pits----------- ------Lining material----.------------------Size: Diameter------------------------Depth---------_---•------•----------_- y Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material______..______________----__.__-_._-. j ❑ Size: Diameter--------------------------------------Depth----•---------------------------•-------------------Liquid Capacity-------------- --------gals. W Privy: Distance from nearest well---------------------------------------------------Distance from nearest building____________-...._._____•--•-_--.-_-_-__. ❑ Distance to nearest lot line-------=i...--- = Remodeling and or re airi 'g-(d escr'be):_-- ---------••---------- -------------- - ------------------------ - ------------•--------------...----------- �/ J " -------------•--------•.------------------------- ------ -------------------------------------------------------------------------------------------- 1 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 Local Health District. (Signed) ' - -----------------------`---1--------------------•---------------------------(Owner and/or Contractor) , By:. ----------- ----------------------------------------(Title)-----------------••-------------------------------------------- (Plot plan, showing size, of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). R FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----= = DATE q I REVIEWED BY �---=-----i-•---------------------------•------- DATE BUILDINGPERMIT IS5UED--�.....................------------------------------------------------------------------------------ DATE----- -------------------------------------------------•----• Merations and/or recommendations:_.._ ____ _________ _ _.______ --___ " -----• '�' •, ---- -- `-- - - - fi ......... ---••------------- . - � -------------- . . -- --- -•----------------------------- --- ----- -------- -----------------•--••--••------------•-------•-••---._...---------•---------••--------._---- I FINAL INSPECTION BY...-O,----- - •- ---------------------•---------- Date-----1 `� i 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 EB 9 REVISED B•59 2M .9-61 ATLAS