13027 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE; -------------------------------------------- AMPLICATION FOR SANITATION Vr_RMIT Permit No. ............ ------------------------------------------- ----------- (Complete in Duplicate) -This Permit Expires 1 Year From Date Issued Date Issued ---- > ------------I-----------------I------ ------------------ Application is hereby made to the San Joaquin Local He6l+h District for a permit to construct and install the wo a imn cr ID This application is made in compliance with.Count Ordinance No. 9. --- ------- JOB ADDRESS AND LOCAT -------- ------------__----------- Owner's Name--- ---- ------------------------ ---------------------------------------------------- Phone_._..... Address-------'ArM& ------ I -t--------------------------7--------------------------------------------------------------------------------------------------- --------------- --------------------- Contractor's Name--- - Pone....._.. ------------------------------- Installation will serve: Residence Apartment Ho;:uSe E] Commercial E] Trailer Court 0 Motel 0 Other units:--/-- Number of bedroom' Z. Number of bathsu�.... Lof'size ,Number.of living s ------ 9 Water Supply; Public system El Community system El Private`i�,Depth,to Water Table 411 ff. Character of soil to a.depth of 3 feet: 'Sand [-] Gravel [] Sandy Loom C?00"Clay Loam El Clay [I Adobe El Hardpan 0 I Previous Application Made. (if yes,date--- ------- ------1 No`r7L0""New Construction. Yes �No 0 FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS. 7-9-z— (No septic tank or cessp?oll _permitted jfpublic.sewer is availabfLi within 200 fee+.) V 4 Septic T nk: Distance from nearest well-----—--------Di'stance-from foun-dafil -------------- ---IV-----_.Mategai--- 04,fo/ • 'Miquid depth__,%<jr.,,----------Capacity._, Ile No. of compartments ------ Disposa Feld: Distance from neares well.-_.-"'r'— ._Distance from foundation... ---Distance.,to nearest lot tine--'------------ mch__ ---------------------- Width of trench__Number of-lines__ __-Length.of each line- - ----------------- ---- ? aterial-/op"', -.-,-Total length-, we------------------------ Type of filter ma�er-,a_1,/___- epth of filter rn Seepage Pit: Distance to nearest well-----------------------bistance from foundation--------------------Distance to nearest of line--------------_- ElNumber of pits----------------------Lining material----------------------Size-. Diameter-----------------------Depth---------------------------------- Cesspool: D.isfance from nearest well-----------------Distance from fou.nda'f ion - -----------------Lining material-___-.___.._---__------__---__---._-_.- --------------Depth--L-` I � 0 Size: Diameter-------1-1-------------- -----------------I------------- - -_;-Liquid Capacity-------------------------- Privy: well-,-.-----.-'_____..__'71f ---- nearest building_____________-------------------- Distance from 'nearest . ..r----------------- ---Distance from e 6j ❑ Distance to nearest lot line.------------------ ------------- ----------- ------------------------------------------------------------------------------------------ 4 LR'6mocleling and/or repairing (describe):----- --- ---- - ------ 7721K ---------- ---I——----------------------------------- lo-I------------------- ---------------- ------- ----------- -------- __J____ -------------------- ---- -------- 7--- ---- -;_ ------- ----- ------ ------------------------------------------- ,4 ---------(6----------------------------------------------------i-----------------------I------------------------------------------------------------------------- ---------------------------------------------- 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 and r gulations of the an Joaquin Local Health District. Ilk I/ igned)----------------------------- ---------- ------------------------ ---------�L (Qw�t�or Contractor) - ------------- By:---------------------------------------------------------------------------- ---------------------------(Title)---- (Plot plan, showing size of lot, location of system in - on to wells, buildings. etc., can 6� placed on reverse side). r> FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_----- - ------------------------------------------- ----------------�_bATE-_'_ -------------- - ` - " "; DATE------------------------------------------------------ or REVIEWED-BY:-`------•-__I----------------- ------------------------------------------------------------------------------- ) DATE------ ---------- ---------- UILDPERMIT ISSUED--------------------- ---------- ------------------------------ -------------------------------------- -1--------------------------- I ----_------------------------ --------------.,Alterations a nd/or . --------- ----------------- ...6,4� - ---------- r--------- _9 =_i;-------------------------------------- ---------------------- ------- --------------- --------------------------------------I-----•......-•-•--------------------------------------- -- ............)--------------------------------------- ... --------- --------------------- --------------------------------------------------- ---------------------- ---------------------------- -------------------------------------------- ---------- -------------------------------------------------------------- j I ---------------------- --------------------------------- --------------- -------------- --_------------------ ----------------------------_---------------------------------------_------- --------------------- FINAL INSPECTION BY-.. )--- - -------- ---------- -------- ---- Date: r -4- ------------------------------------ SAN -----------------------------------SAN JO AQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California M� t a,California _ES-9 REVISED a-sy r.p.cD.2M G-60 Y an Is@ Tracy,California