7625 - Laserfiche WebLink

Home Browse Search

V APPLICATION FOR ._ANITATION PERMIT Permit No. .... .. (Complete in Duplicate) y� Date Issued plica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. OAptis application is made in compliancewit C yr�ty rdinance No: 549, JOB ADDRESS AND LOCATION.... ___-__------ .- -C /—_W---------------------------------- Owners Name n _ n _ _. .. �. _. _.. Address---•-L , 4 -••--------- -----•--------•-----------------------------------------••----------------------......---•-------:.--.-.-..-..----.-•- Contractor's Name-- R .X � # -----••-------------------------------------•----•-------------•-•---•----•-_••--•-•----•----•-----•-- Phone-- -- �3 'G� Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [� Other ❑ 'A / Number of living units: -__1_._ N b' of bedrooms __��► Number of baths _1_____ Lot.size ______�__f1_.-__ __ Water'Supply: Public systam" Community system ❑ Private ❑ Depth to WafBr Table .-.-_--_ ft. \ Character of soil to a depth of 3 fee+:"Sgind ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe&KOHardpan ❑ Previous Application Made: Yes ❑ No "New Construction: Yes Q1_61 ❑ F TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tan0or cesspool permitted if public sewer is available within 200 feet.) ��itpposa Septic Tank:. Distance from nearest well_______________-Distance from foundation__._.__.:__-__---__.Material--__________._________.___-__-----_.--__________- No. ofcampertments ----------------- Size r - Liquid depth Capacityl F', Id: Distance from nearest well.................Distance from foundation--------:____.__=_.Distance,to nearest lot line----------------- Number of:lines-----------------------------------Length of each line-.----------------'---------.Width of.trench----_------- :---------- Type of filter material-----------------------'Depth of filter material-----------------------Total length------..._-__-------------------------__._ AA Seepage'Pit: Distance to nearest well _- -A.-_._.,_____Dist - fro foundation____6-. ..Distance #o nearest lot lin A " Number of pits___11_________________Lining mater', Depth Diameter__-- .---- De th_..-_ --------------- Cesspool• Distance from nearest well-----------------Distance from foundation-______-_-__-I---__.Lining material---------------------------------------- 0❑ Size: Diamete r------------------------------------'Depth-.-----------------------------------------------------Liquid Capacity--------------:------- -----gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest- building------------------------------------- El ,. A, w-----: -------- ------------ --- ------ ---------------- - ---•- DataRce to nearest IoMone____'_________-------------------------------- -- ---- -- _ Remodel', g and/or repairing (describe):------ --- -------------- --- - --------- ---- ------------------- ..... ------ ------=-------------•----._.---=--•----------_---------------------------- ----- ---------------•------•------------------------=-----•------•-••--------------------------------- ------- ---- •---------------•--•-•-_-----------------------••---.-.- ' x ------------------------------------f---------------------------------------------------------------•-------••---•----------•------------------------ I hereby certify that 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) 'Q�----------- ---------'---------------------------=----- - ------------------------------------------------- (Owner and/or Contractor) By: t - [Tale}- •------------- -- ------- ------------------------------------- ----------------------- ----- (Plot plan, showing siz of lot, location of:'system in relation to wells, buildings, etc., can be placed on re se side). i ;. : .; . FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY 3 DATE .---•-------------------------•-• ------------------ a------- - -- ----------- ------------------------------------------------------------------- REVIEWED BY---------------------------- r - DATE---rk-----------------------•-••---••------------------ BUILDINGPERMIT ISSUED_.--- � -------------------------------------------------------------------------------- DATE------ ------------------------------------------------ Alterations ----------------------• •-- Alterations and or recommendations:. -- ----- ------------------------------- • --- A ---- ----- - - -------------------------•-•-••--------------- -------- w --------------------------------------- ------- A FINALINSPECTION BY: ==---------------------------- Date------ -.. ..'_ ------------------------ SAN -------------------SAN JOAQUIN LOCAL HEALTH DISTRICT 134 South American•Street 300 West Oak Street 132 Sycamore Street 814 North •'C" Street Stockton, California Lodi, California Manteca, California Traey, California ES-4-2M Revised W-210Q_ r 4