9984 - Laserfiche WebLink

Home Browse Search

APPLICATION 1=0R SANI PERMIT Permit No. [Coiiin ( te in Du _1 ate'�X IrES 0 � y � pate Issued ___.!C_S -- PP011 DAT--' Application is hereby made to the San`Joaquin Local Health District for a itx#r�.cstrG and insta I the work herein des6ribed. This applicationis made in compliance.with Count Ordip nce No. 549- -0 JOB ADDRESS ANS LO TION__----- -_l�_�_ , _-_.'___- _____ ______________h}___._-..___ -_- ___-_________________---_____________-________________-_--__-__-_____ """ -----. Phone Owner's Name i g -------- -------- ------ ------ ---- Address-........ fid. F ----------------------------------------- --- -------------------------------------------------------------- Contractor's Name_ '' ' + - Phone = --- - -------.-------- installation will. serve: Reside ce Apartment House ❑` Commercial ❑ Trailer-Court ❑ Motqp1 ❑ Otherr--E-----.-. Number of living units:_' umber of bedrooms _ _ Number of baths __r-___ Lot size •-------•- r , Water Supply: "Public systemjy�comuriifymsyste0[].••1Private ❑ Depth to Water Table ___'-__ ft. Character of soil to a depth of 3 feet: Sand.• Gravel ❑ Sandy LoV� N � Clay Loam ❑ Clay ❑ Adobe �ardpan ❑ . Prev ous Application Made: Yes ❑ .No New Construction: Yeso ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AD SPECIFICATIONS: i [No septic tank or'cesspool permitted.i ublic sewer is available within 200 fee .) Septic ank: Distance from nearesr welL__ __Dista e fro tau aftion__ --------------.Material __ ____ _ _________ ___.....__- ___- --- - l _ i•= No. of compartments _-- - t - :----_Li uid e , h---'------ -------.'Ca acit fi� _' p r q p , p Y ' � _ ___ _ -_ Size i. Disposal eld: Distance from 'n s' of Tef�undatiori� --------------- l - _ Distance to nearest lot lin � Number of lines----____--_ �,-- g ch line=_ s: � : l .Width of trench--------_--r- i Type of filter materi �cth of filterra�aterial I± _ ____Total�length �___CJ _t___________ Seepage Pit: Distances to nearest•well ___ -______ Distance froaoundation___________________.Distance to nearest lot line----------------- ❑ Number of pits:_________________---Lining material__ _____- Size: Diameter----------------------- ' r *----- --- ,Depth--------------------------------- m - ------------------- ------- .Cesspool: Distance from nearest well---------------1=Dist•nce fro m foundation_;_._-___----------.Lining material-----------------------------__-__-___. �•- ❑ Size: Diameter------ ------------------------------ Dept--------------=-- •----------------------------Liquid Capacity- ------------------------ gals. + Distance from nearest building----: Privy: i Distance from nearest well _' --------- - \J ❑ .,"Distance tornearest lot=line--------- ------------ _ -- - , Remodeling and/or repairing {clescribe):_---_°___________________ _ ---------------------•-•---------------------=----------- ----=----------------------------------------------------------••---------------=---`---- -----------------------------------... ---------------------=------- -------------------------------------------- ----------------------------------------------- I hereby certify that I have prepared this application and that the work will -be done in accordance with San Joaquin County ordinances, Stlaw , nd rules and regulations of the San Joaquin Local Health District. +I- � - [Owner and/orContractor) ------------------------------------------------- (Signed)- v [Title ------------------------------------------- By:-----------------------------------------------�------ ------------------ ---------------------------------------- ----- - I (Plot plan, showing size of lot, location of system in.relation to wells, buildings, etc., can be placed on reverse side). _-4 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----------------- DATE_- ------ ----------------------- ----------------- REVIEWED BY---------------------------- . ------ ---------- ---------------------------------------- DATE 4 BUILDING PERMIT ISSUED---------------------------- _1- ---- ----------------------•------------------------- ------------•--- DATE:-------� -- -------------------------- -------------- Alterations and/or recommendations:----------------------------------------------•-•--•-------------------------------- -----------•--••----------------------------- ------------------------------------------------------------------------------ ------------------------------•------------------------------------------------------------------------------------ ----------------- ---------------- --------------------------------- i •---------' - ------------- - ---- -'-- ----- t� FINAL INSPECTION BY:_--- 1 .-----_- _ ------------ ` Date-----------y [ w SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street 'Stockton, California Lodi, California Manteca, California Tracy, California ES-4-2M Ravisea 1.57 F-RCO- °'� �'"