22640 - Laserfiche WebLink

Home Browse Search

..............U,3C: , /a —�D - . fit '3 D •-� `� - --- ---------------------- ------- ___- _____.__ . APPLICATION FOR SANITATION PERMI-P� �� Permit No. `............f.. - ------------------------ - -- -- - U (Complete4n Duplicate) --_ -- - This Permit Excires 1 Year From Date Issuedd / ,7;t Date Issue �_ -. Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with,County Or nce NO, 549. JOB ADDRESS AND LOCATION ------------ `--`----- --- ---t----- -� -- ------- Owner's Namerl7L------------------------ ---- ---- f'g•S' Phon Address _I7'1._�- ----- -------------- - ----------------------- --- Contractor's Name__ �• Installation will serve: Residence Apartment Housr-.,,el mmercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: _/-__ Number of bedroom ❑umber of baths . .____ Lot size _.Water Su I Public system Community systemte ❑ Depth to Water Table -60 Supply: Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Cla f t { F� 1 {. Previous Application Made: (If yes,date_.______________ No Y ❑ AdobeX Hardpan ❑ I 1 ❑ 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.) t�Spp� Distance from nearest well_______________Distance from foundation-_ --- .._._______.__. f!I y No. of compartments-------- ------ ------------ ....... - Size Liquid de th - Capacity Dis Distance from nearest well-140-0-F,Distance from foundation- ._.._.Distance to nearest lot ine___ - t>�1 Number of lines__.�----------- -- --_----_Length of each line-.��// Q!-,. n Type of filter materia._ `/ ��r ---Width of trench.-_,,-! --- '�1�L _._-___Depth of filter material__--. -_- i - Total length M1s• i Distance to nearest well_1"*�0 _ Distance from foundation--- •_--.Dista�e to nearest lot line__..12 Number of pits--. .1____.___.___-Lining mate N' 4-tgLE Size: Diameter- --- Cess ool: ----------Depth Distance from nearest well ❑ Size: Diameter. _ ____._ Distance from foundation-_-_-_ _ . __-.__ . Lining material_.-___.__._._.___.- _ - -- --- ________.__Depth--------------- ----- ................... .--- Liquid Capacity... ---------- Priv - - ---- - ------------------------gals. Y� Distance from nearest well____-_---_-__-_- _ --- _Distance from nearest building---------------------------------------- ❑ Distance to nearest lot line__ __ __ - --------- Remodeling and/or repairing (describe):_------- -_ ----------------------- -_ ' ------------------------------------- ---------------------------------------- ---------_------------------------- --- ------------------ _ 7----------------- _ --__-- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta a laws, and rules and regulations of the San Joaquin Local Health District. (Signed)_ C3 BY:--------------------- Contractor) (Plot plan, showing size of lot, location of system in relation wells, build' gs, etc., can be placed on reverse side). ------(Title)---------- ------ ------ -------- F R ARTMENT USE ONLY APPLICATION ACCEPTED BY----_---_ REVIEWED BY_..__--.---__ - - --_ DATE.._ - 1- 9=t/ -- BUILDING PERMIT ISSUED__________ ___ Alterations and/or recommendations:______ __ ___ -___ _ _ .______--__---- - -- -- -------------- DATE.____.--_--_---___-_-------------- -- ------------------------- FINAL INSPECTION BY:- �� Date. -- / ,� - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:*Ifon Ave. 300 West Oak Street 124 Sycamore Street Stockton,California Lodi California 205 West 9th Street E.H.9 2M 1.67 Vanguard Press Manteca,California Tracy,California