13231 - Laserfiche WebLink

Home Browse Search

i,QFFICE USE: 14 ------- ------=-------- ------ / � ` -t.__"�_: __'______. APPLICATION_!RORYSANITATION PERMIT Permit No. ..�..a�..E�..�1 -------- ---- ----------- (Complete in Duplicate) `" . This Permit Expires 1 Year From Date'Issusd" Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct nd ii(n�stall a work h�reia described. ti This iPplication is made in compliance wit C unty Ordinance No. 549. n %1OBIj1 ADDRESS AND LOCATION____ xe - Q;Z;---------- - ------------------ 4, t _ '757 .wr.ier s.Name •----s '1. � - --------�---- ---- Phone------------------------------------ ddress-•---------15;U4?-y-----4e-flt t _ �- --- = P Contractor's Name------------ � � --------•------- -------------------------------------- -------_-_ Phone................................... --------------- Installation will serve: Residence Rq-` partment House'❑ Commercial E] Trailer Court ElMotel [:1 Other ms� Number of living units: .___ Number.of bedrooms �..7-_- Number of baths � ,Lot sizes .:................................. Water Supply: Public system ❑ Community system Private E' ] Depth to Water Table /f ft. i f Character of soil to a depth of 3 feet: ;Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam EEr Clay ❑ Adobe ❑ Hardpan ❑ T Previous Application Made: (If yes,date--------------_-----) No [J� New Construction: Yes J�No ❑ FHA/VA: Yes F�j— No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) l Septic Tank: Distance from nearest well----"--------- ---Distance jrom foundation----Ap-------Material---�c__L��/-_ l " No. of compartmentts______/ - ---Size-It: ...Liquid depth---X._/ *" Capacity_ Disposal Field: Distance from nearest well.__._� '____.Distance from foundation__�_�Q....-.Distance to nearest lot line__ er of of bof filter materi� ________--------Depth hofffilter�mlateria ��_----To tal hlength_nC _�' -------------------- Type Seepage Pit: Distance to nearest'well-------_--------------Distance from foundation....................Distance to nearest lot line----------------- El Number of pits------- ------------Lining material------------------R....Size: Diameter.........---------------Depth------------------------------- ... Cesspool: Disfance from nearest well_________________Distance from foundation___________-_.___-lining material---------------------- ------------- 9i ❑ Size:'Diameter------�-------------------------------Depth----------------------------------------------------Liquid Capacity-------------------------t-gals. i Privy: Distance from nearest well----------- ---------------------.----------:._Distance from nearest building-__-_---____-________________-:_--______: ❑. Distance'to nearest lot line ---------------------------..... ------------------------------------------------------------------------------------------------ --------- Remodeling and/or repairing (describe)-------------------- ---------------------------------------------..-------------------- -------------------------------- y i. -----------------------------------------------------_________________________------------------------------------------------------------------------------------__----------_-------_--------_-----------------_------------ ' I hereby certify that I have prepared this application and-that the work will be done in 'ac -with San Joaquin County i ordinances, S+a+e laws,"and rules and regulations of`+he�San Joaquin-Local Healtki bis+ric+. (Signed)------------------------- -*44-••---- ----------------------- - ------------------------------------------------- /or Contractor) -------'��---- ------ .(Title)--- �---------------- - ------- ---- t By==---------------- = (Plot plan, showing size of lot, location of sys+em in relation to wells; buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY E ----- -------=---------•--•--------=-----_----- DATE------... ��f REVIEWED BY ! --------------------------- DATE---------------------_---------------------- ---------------------------------------------------------------------- --- BUILDING PERMIT:ISSUED:-----------------------------=--------- ----------------------_--------- ------------------------- DATE------------- - Alterations and/or recommendations:---- -------------------------=-------------------•-----------------------=------•------------------•-•------ --------•--------- ---- { -------•-•-----•--•--•-•---•-----------------------_:---------••----------•-- --------•------------------------------------ -••--------••------=------•----•------------•------------•--------------- -------------- � l -------------•----------------------------------------------•-•----------------------------------------------- -----•---------------------------------- -----= -- ------ --------•---- --- --- --------------------------------------------------------------------=--------------------------------•-----------------•---- FINAL INSPECTI Pd— --- + - Dafe------W-- ..-----••--• I SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 20.5 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California E9.9 FEVIBED 9.59 F.P.DD.1M 6.6D „w,Q i