16340 - Laserfiche WebLink

Home Browse Search

W FOR OFF U °'--.-- ----- -�j_ ------ APPLICATION FORSANITATION PERMIT Permit No. >� --------- - ------------- _ ;---- --------- (Complete in Duplicate) --------------- -- ---------- Expires - - --- �--------��-- --- This Permit 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and insfall the work herein described. This application is made in compliance with County Ord-n e 544. r ' JOB ADDRESS AND CAT PON---- Owner's Name i ------------------ - --- -- ----�A—------------------------------- r -------- Pho / Address.---------•-- € ---------- n --- {f-� --_.--- - -------- - -----------------A------- Contractor's Nam = ' cE -- --:---------- Phon _ Installation will serve: tResidence �] Apartment HousFLA Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___ Number of bedrooms _:_ umber of baths _ ot size Water Supply: Public system ❑ Community system ❑ Private epth to Water-Table 110 ft. Character of soil to a depth of 3 fee+: Sand Gravel Sand Loam, Cla Loam Cla p ❑ ❑ Y [] y- ❑ *q"HA/VA: Yi❑ -Adobe Hadpan ❑ Previous Application Made: (If yes,date___________________) No ❑ New Construction:' Yes ❑ No Yes ❑ No ❑ F INSTALLATION AND SPECIFICATIONS: [No septic tdnk or cesspool permitted if public sewer is available within 200 feet.). e c an Distance from nearest.well_-____.__.______Distance from foundation____________________Material_____.._- No. of compartments-----------------------------Size---------------------------------Liquid dep�-------------- ---------Capacity----------.----- ---- os i Distance from nearest well-470------Distance from foundation.- -Dis#ante to nearest lot line- Number of lines_____- -_�__ ____ _______ _ _Length of each line___ -_- - - Width of trench________'l .J• t� 1� -` 6, Type of filter material-- Depth of filter materia___.__�_ ___Total length-__.______________13Q------ it: Distance to nearest well--�_0- __'----_Distanco f om foundation____ K'o f� / le--_.Distance to nearest lot line-------C_ W Number of pits---I_______________Lining material_____- oC7oundation ------Size: Diameter-__ ' -.� Cessp : Distance from nearest well______--______•_Distance from ____ material__._-_________. ❑ Size: Diameter-------- ------------- -----.Depth----------------------------------------------------Liquid Capacity--------------- -------gals. Privy: Distance from,-nearest well--------------------------------------------------Distance from nearest building ❑ Dis#ante to nearest lot line -------------------------------------------------------------- Remodeling and/or repairing describe):__.__-. t ------------------------------------------------------------------------ - -- -- - ------------------ ----- --- ---- ------ ' ---•--------------- - --- ------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County k ordinances, Stc to Laws, and rules and regulations of the San Joaquin Local Health District. i (Signed)--- - - - ----- Q-(-,-�--`1-- A� � -T4---- •�'----- r - - - -------------Title----------- - --- BY:------------------I---------------------------•------------------------------------ Contractor) (Plot plan, showing size of lot, location of system in relation o wells, buildi s, etc., can be placed on reverse side). ' ) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------_ ---- ----------- - ---------------------- DATE REVIEWED ----- DATE BUILDING PERMIT ISSUED -------- -_-_ ----------•r-----�--�---------_----�-- � -------------- DATE----------------------- Alterations and/or recommendations:__-___.. _.�-_ _'Ini--- --_ �_ _t ^ - -- - "�-t-�.�G.--=-.---=�-�rcr--1_�-� � . �o - I --------- ------ ------- ---------------------- ----------------- -------------------------------- ----- FINAL INSPECTION BY:..!_�L. __------ _- - �� -------------------------------••---- Date r SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy, California ES 9 REVISED 8.59 3M 3-'63 F.P.Ca,