19129 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ' -- ---�`.�--- ------ ----- -' -- Permit No. .......... ... •- �- --;- I, APPLICATION FOR,:SANITATION PERMIT ! ({Complete in Duplicate) Date Issued __ --!_-`.__6 - This Permit Ex ires 1 Year From Date Issued ict for a permit to construct and install the work herein described. Application is hereby made to the San Joaquin Local Health Distr This application is made in compliance with County Ordinance No. 549. - C ----------------------------••------------------••---------"-- ----- . - --------------•------ JOB ADDRI=SS AND LOCATION_: Phone------------------------------------ Owner's Name..----- - ' - ---- -------------------------•------------ -------- -------- --------- ------- . ------ ---------•-------••------- Address---/7.__ - - : c -� TS -- <• Phone------- ---•- Contractor's Name_-._ _ ' Installation will serve: Residence �Apartment House ❑ Commercial ❑i Trailer Court ❑ .;Motel ❑ Other ❑ Number of living units: __Z -`` Number of bedrooms __2_ Number of baths _.i�_--- Lot size,,._`5-�-��-� -------------- -----•- i Water Supply: Public system C% ommunity system ❑ Private ❑ Depth to Water Table' it. Character of soil to a depth of 3 feet: .SanI ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous A s Application Made: (If yes date - ------------- -I No New Construction: Yes L? n'o El Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspoof;lpermitted if public sewer'is'avaiiable within 200 feet) I a Septic Tank: Distance from'nearest well---'7'------Distance from foundation-/ _ g�� J_ t Size Liquid depfh------------- ------- -Capacity_ - -- — o No. of compartments- --2------------. - - ------ - --- • q Disposal Field: Distance fromnearest well-__._- Distance from found ation 1A-------------Distance to nearest lot life_-._:__..._____.. Number of Imes-__._-�t----------------- ----Length of each line_�.D----.-----------------Width of trench._ . ��-- •------------------ a rr V { Type of filter material` _o�_�C-_.__Depth of filter maternal-E�_ _.-_ -__---Total length___ Q ' nearest lot line_---------- Seepage � Distance to nearest well___ _ _ __Distance from foundaion___�9_____._._.Distce to _ _. SeeP ge Pit: _ � F �" Number of its. _ _ .Lining mafenal-` Qty_/..... Size: Diameter_3.3--------- --_ ---- i ❑ M ia Cesspool: Distance from nearest well---- __._. Distance from foundation.____.--_-.-_.-_--.Lining mater ------------------------ Dept -Li Liquid Capacity gals Diameter------ --=-------- ------- ------- tance from nearest building------ -. - m Privy: _ Distance from nearet wO-------------------------------------------- Dis F ❑ f Distance to neIIarest jlot line----- ------------------ -----------------------------------L. ------------------------------------------------- t Remodeling and/or repairing (debscrbe):------------------.__-___. _----------------------------------------- � ---------- ---- ------------------------------------------------- r I hereby cert-- that I have -.-- •-------------------------------------------- --------------------------ill -- .. .i - c - - --- - -- 'prepared this application and that the work will be done.in accordance with San Joaquin County ordinances, State laws, and rule and regulations of the San Joaquin Local Health District. } -------------------------_(Owner and/or Contractor) Title g . - ----- • -------•-- --- ------- { ).__ f (Plot .plan, showin size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). p- l. FOR DEPARTMENT USE ONLY I --------------------------------------- DATE----- = =�T -------------- APPLICATION ACCEPTED $Y- ----------------------- -- - I $UILDING PERMIT ISSUED l REVIEWED $Y------ ----------- ----- --I----------------------------------------------------- --- DATE. --------------------- -------------------------- --------------- ---------------------------------------------- Alterations -----------------_ ions: -- Alterations �and/or recommendations: r=------------------- e" ------------------------ ---- -----------------"=--- �/ ------------- _-----_-- ----------------- -------._-.._-----_ _-_-- -------" l �3_ --- ----------- ..__.--___ ______________ - , ------------------- -- ----- x ` FINAL INSPECTION BY:.---.-- C.�_ -------------------------------------------- Date--- ---- - (' �5---------- F SAN JbAQUIN LOCAL HEALTH DISTRICT r205.West 911h Street s 1601 E.Hazelton Ave. i 300 West Oak Street 124 Sycamore Street iManteca,California Tracy,California Slockton,California Lodi,California C.P.C 0. %