13412 - Laserfiche WebLink

Home Browse Search

FOR OFFICE Ll .:. L� r� �.�5'C" ter ,. •—�— --_ �JZr J Permit No. APPLICATION FOR` SANITATION PERMIT J ----------- "" _----- (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. { This application is made in compliance with County Ordinance No. 54 a - -- V ----- --- "`- ------------ -'r-•-•-"-----------'� --•�---•�i� { JOB ADDRESS AND L CATION''__________ __ _ _ _______ __ Owner's Name...... !�_ = ,.... Phone -- ,� =: i% - ------------------------------ -------------Address - - ---- - ` Contractor's Name... c , "" -------- - - Installation will serve: Residence ❑ Apartment House ❑ Commercials Trailer Court ❑ Motel ❑ Other ❑ ` ' Q �C ,C-------------- -- Number of living units: ___.._:: Number of bedrooms -------- Number of baths -------- Lot size ._- __.- _ { Water Supply: Public system ❑ Community system ] Private pth to Water Table �4 _ ft. Character of soil to a depth of 3 feet: ISand ❑ Gravel ❑ Sandy Loam [IClay Loam ElClay ❑ Adobeardpan ❑F„ Previous Application Made: (if ye e �' No ❑ pP s,date_______________ "), No ® New Construction: Yes ❑ No �PHA/VA: Yes ❑ TYPE OF INSTALLATION AND SPECIFIOATIONS: `y;� . ( P P P .public sewer is-available within 200 feet.) [ c aA: Distance fromllnea dst well---- ; i Material----------------------------- No septic tank or cess o01 --_____{r.__-__.Dis#ante from foundation_________________ _ -.', ' ---------Capacity No. of compartments--------------- ---�- Size---------------------- -------- Liquid depth P Y Len n of each Ibndation•__________________Distance to nearest Eat line---------._.____or o, Dis sal field: Numabee of lines�arest well -_.=--___-------Distance from.fo Width of trench._____________--------------------- f X _ g ne-------- Type of filter material------------------------Depthoff filter material------------------------Total length--------------.-------------:•-------•---� I'- __:.___.Distance to nearest lot line-� ... k Seep g� Pit: Distance to Dearest well��_____-_____Distance-{rqm fo/�ndation_.- Lining materiaG-1 -- Size: Diameter--- ---�.......Depth----r ------------- --- Number of its_ ._ _ ------------ F li 1_ Cesspool: Distance from`nearest well--_.___._-_____.Distance from foundation____________________Lining material ------------------------------------ cesspool: .____.__.____._---- els. ❑ __--Depth---------------------------•------------------------Liquid Capacity-------- -------------------9 Size: Diamete`r.�'`:_____________________ ___ ;,. _ ; t Privy: Distance from nearest well________________________ ---_____.__._Distance from nearest building_____________.________.________._..__--._. ❑ Distance to nearest to+dine - ------------------------------------- Remodeling and/or repairing (describe):__.__ ---------------------------------------------------- l ------------------ -•-----•------ ----- -----• ----•------• t --- --------- --------------------- -- ------- I hereby cert' that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta I s, and ru s-arfdl egu tions of the,San Joaquin Local Health District. Contractor) {Signed) t ` z ------------------- }i caner and/or Q - - ------------------ --------- ---------------- - - BY:-_-------•----- - N --=-------•-------"`a'` /�- (Plot plan, showing size of�=lot, Iocation,bf sysfe n relation to wells, buildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY i ------------------- APPLICATION ACCEPTED B - -------------------------- DATE------ ��•U. EVIEWEDBY '= :' -------------------------------------------------------------- --=-- DATE =- +iILDING PERMIT ISSUED------ ------------------------------------------------------ DATE"-------•------------------- ---------------------••--------- -- ---------- i srefions and/or recommendations:/`-�� "-_ -- "2 v - "' , '`--•-------•----- -----------� "-�'------=-=------"---------------------- --------------- •---------------------"------------"-------••------------•--------•------------•---•-;-•-----------••-------•------••-- 1111 t - __---- -------------------------- 1 ; - ii -----"---------------"•-------------..-.------------------------------------- ------------------------------ ------------------------------------- . ------------------- l 1 ------------------------------------------ Date--....... INSPECTION B SAN JOAQUIN LOCAL HEALTH DISTRICT n 5+real 300 weal Oak Street 124 Sycamore Street 205 West 9th Street i Lodi,California Manteca,California ,; Tracy,California