8911 - Laserfiche WebLink

Home Browse Search

+ APPLICATION FORSANITATIONPRN"iflF- Permit No. I •: > - , (Complete in Duplicate) ti . D ) Date Issued 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 Z'a nce No. 549. ct JOB ADDRESS AND LOCATION � �- _t. --- -AOwner's Name--- -- ------- Address--------- ddress_-•------ -k- J-------^-I ----- - -----------------------------•------------------- ------------------------------------------------ ------ ---------- ----- NameC�. ------ Phone----------------------------------- Contractor's --- -------------------------------- Installation will serve: Residence Apartment House ❑ Commercial E] Trailer, Court E] Motel ElOther ❑ Number of living units: __ ___ Number of bedrooms - ! Number of baths _1__._ Lot size ------ Water Supply: 4Pub'lic system Community system ❑ Private ❑ Depth to Water Table _------ ft. Character of soil to a depth of 3 feet:� Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Aclobe j; Hardpan ❑ i Previous Application Made: Yes ❑ 'NocWt New Construction: Yes No ❑ FHA/VA: Yes ❑ No ❑ ' I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitfed if public sewer is available within 200 feet.) Septic 1 Tank: Distance from nearest well___ Distance from foundation_-------- MateriaL__CC ------------ No. of tom artments__`_ _______Size___ i uid de th_______ tY .__.____. ___ _------- Ca aci _ Disposal Field: Distance from nearest well----st-0_.._.Distance from foundat'on_______ _____.Distance to nearest lot line]/4�_________. t Number of lines--____- ---------- ---_----L th of each line--- -CS'----ti--------.Width of trench-_--- --------------•---- Type of filter material_ er material___-_$___________.Total length____ } Seepage Pit: Distance to nearest well _____ __ ___:__ _ ______'_Distance from :foundation____________ ______Distance to nearest lot line_________.-.___._ �[1 ❑ Number of pits--------------------- Lining material-----------------------Size: Diameter------------------------.Depth------- \ Cesspool: Distance from nearest well___________._-Distance from foundation--------------------Lining material-------------------------------------- Size: Diameter = Depth------------------------------ Liquid Capacity gals. "V Privy: nearest Distance from nearest well---;.---------------------------------------------Distance from nearest building-------------.---------------------------- ❑ Distance to nearest loft line-- ------------------------------------------- Remodeling --------------- --------------- ------Remodeling and/or repairing (describe):-- ------ ------ ---hL? -----•--------------------------------------•-- y - -' - --. ------------------------------------------- -------------------- ----------- --------------- -- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) ------------------------------------------- - (Owner and/or Contractor) Title a (Plot plan, showing size lot, location of system in.relation to wells, buildings, etc., can be placed on reverse side). OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----i----------------- ----- - -- -- ------------- : ---------------------------------------------- DATE--- �1-•-------------------------------- -------------- - REVIEWEDBY-----------------=---------------------------------- ------- ----------------------------------------------------- DATE-------- --------------------------------------------- BUILDING PERMIT ISSUED_ `._---- ----- -------------------- DATES 1 Alt Eons and/or recomm - ons:-------- 4 od - 4 ------------------ - - --------- - I 1 � - U FINAL INSPECTION BY:----------= �-� �"-------------- Date. ''�' fi F - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Soo West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California _ Lodi, California Manteca, California Tracy, California I-Vv rriG �1 r,c3unL F//mac. u„ .y�, 1 {•�/ - j` 'r,–❑ (r//4 ES-4-2M , Rev;sea 1-57 FY CO. 111