18199 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: l Ga APPLICATION F ----- ION PERMIT ��y•-- --- - - ----------- ----- ---- Permit No. .__,l ----- ----------- OR SANITATION '• ----------- - — (Complete in Duplicate) 4 Date Issued _/�-_-___�-- ---------- This Permit Expires 1 Year-From Date Issued - ------- ---- --------- Application is hereby made to the San Joaquin Local Health District-fol a permit to construct and install the work herein described. f This application is made in compliance with County Ordinance No. 549. 3 J08 ADDRESS AND LOCATIO - `" _ = - = Owner's Name -- - s .F --------- -- Phone- - �. - •--------------•----•-•-- Address---------------- 46-41,5---- ---------�9�-- ---- Contractor's Name- -------------• ------------------ - ----•-•------------------------- --------- ----------------------- Phone---------------•------------------- f Installation will serve: Residence ® Apartment House ❑ Commercial [] Trailer Court ❑ Motel ❑ Other ❑ r q I ,Number of living units: __�____ Number of bedrooms .-A—Number Number of baths-1- - Lot size'__--4-0-�-------1-• --•--------------------------- a Water Supply: Public system 54 Community system ❑ Private ❑ Depth to Water Table -------- ft. ;: Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe§4 Hardpan ❑ Previous Application Made: (If yes,date_.-------------....) -No New Construction: Yes ] No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1 Septic Tank: Distance from nearest well__oVj,!!'7�Distance from foundation___-,/-1----------MateriaL...- - - ---------- de th._._.--_-----------------Ca acct &ofOb_--- No. of compartments------- -4 --------Size---11/-X-,?.x--6---Liquidp. p Ye Disposaall Field: Distance from nearest well:___. _.Distance from foundation___/.0-�-____.Distance to nearest Loi;line--.�___._-____ � Lil Number of lines---------- ------ '----- Length of each line-------------17Q. -------Width of trench__ •--.----------------------- y m Yp -__Depth of filter material-----_-__ Total length_____-..-__ _Q_____--------------- ____ T e of filfier.rrsatenaL__�1?P!__ �- --- - f its e swell Distance f om oundation--_ ___._.-___.Distance to nearest lot line y _____-_ �, �__ See a Pit: Numb8re oo nearest j Lining material__Z, - ---Size: Diameter__�.�____ _________Depth_._-__. ___._--:-----.---- p ---F-- ---- Cesspool: I Qistance from nearest well-------_---------Distance from foundation--------------------Lining material------------.------------------------ ElI Siie: Diameter------ ------------------------------ Depth-- -----------------------------: -------------Liquid Capacity---------------= _ gals. i Privy: Distance from nearest well------ --------'---- ------------- ---__._..-Distance,from.nearest building-------------- -----------•----- - -----� � ❑ Distance to nearest lot line--------- ---- ------------------------------------ -------------------- " , -- Remodeling and/or repairing (describe)---------------------- ---------------- - ------ -------•-----f -----------:- -------------------------------------- Y i - ---- ------------{$----------- ---------------•----•-------------------------------•----------------------------------------•---------------------------- - I hereby certify that I have prepared this application nd that the work will be done in accordance with San Joaquin County s. ordinance's; State aws, nd rule and regal ons{of the n Joaquin Local Health District. Si ned -------------------------------------- ------• (Owner and/or Contractor] tI ------(Title)--------------------------------------- ------ -- --- By:--•----------------- (Plot plan, showing.size of lot, location of system relation to wells, buildings, etc., can be placed on reverse side). l FOR DEPARTMENT USE ONLY ! T ------------------- APPLICATIACCEPTED BY--- ---- -- --- -----` ---------------------------------------------•--------- DATE-- �f ®- REVIEWEDBY------------------------- DATE----------------------------------------------------------- BUILDING PERMIT ISSUED------------------------------------------- - --- : DATE t Alterations and/or recommendations:___-__..__.__.._ -----. F - - _ --- ----------_ -- ---------------------- ----- ----- ------------------------- ------- ------------- ------------------=----------- ------------------------------ -------------- L° / Date-------- o�- �---C----------- FINAL INSPECTION BY.---------- __.__ -------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT ki 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California F6 9 REVISED 8.59 3M 3-'S3 F.P.CC. �- t