22018 - Laserfiche WebLink

Home Browse Search

R FFICE USE: Permit No. G�-------------( -------- APPLICATION F04 SANITATION PERMIT --- -------- -- Date Issued .�-�-----`--- ---- ----- (Complete in Duplicate)------------------ -_- --- This Permit Ex ices I Year From Date Issued - rict for a permit to construct a tion is hereby made to the San Joaquin Local Health Distnd install the work herein described. Applica Y Tis.app�ication is made-in-.compkian wit Count Ordinance No. 54 . OF ------------ JL IN - JOB ADDRESS AND LOCATION -. s.-. _ ----- _.-_ Phoned(1&1774 Owner's Name------ ----- --- --- - ------- ------------------------ - ---•--•--------•- a s cls-------- -- Phone—d4&- I-Fi--P - --- - ----------- Motel ❑ Other Contractor's ame---------------------•---- - Trailer Court ❑ Installation will serve: Residence 0 Apartment House ❑ Commercial ❑ , -- Number of baths .-�- -- Lot size ��-�----f�- ------------------ Number of living units: A-_-- Number of bedrooms _7/ - Communit Sys ❑ Private ❑ Depth to Water Table ------ - ft. Water Supply: Public system ❑ Y Y Cla Loam ❑ Clay C] AdobeK Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam C1 ay No HA/VA: Yes No� I Previous Application Made: (if yes date--------------------1 No� New Construction: Yes F ❑ l TYPE OF INSTALLATION AND SPECIFICATIONS: , (No septic lank or cesspool permitted if public sewer is available within ' feet.) f Material_ -- Distance from foundation.- ------------ ,1 f Septic Tank: Distance from nearest well-IUN -- Liquid de th._ Z--------- ----Capau}y__�. d No. of compartments_. -------------- Size_ . - G p' r _Distance from foundation..�0, _-.-•-----Distance to nearest lrot line__ _-_.----- Disposal Field: Distance from nearest weil,lV( - Length of each line ---------------W�dth of trench. ---1 ,--- - I Number of lines__G1'7� -.CI �/�, g rf ----Total length-----3--�� Type of filter material-.-`�►` _---Depth of filter matenal.__.�._ ---�- Pit: Distance to nearest well_�OlipE'------Distance am f . ndation- Q----- Distance to nearest lot liner•._.._-___ Seepage Linin material--- u Size: Diameter-_4 - -------- Depth--- ---- I Number of pits g Distance from nearest well----------------=-Distance from foundation- ..--.._-.-_--..Lining ing Catera it gals. Cesspool: Capacity Size: Diameter--------------- ------ ----- ------ Depth----------- ------ ------ ---- ------ ------ -- q Distance from nearest building------------------------------------------- nearest ---—-------------------- Privy: Distance from nearest wei4_: = ------------------- - --- Distance nearest lot linen---=----------- - - ----------- ❑ ---------------------------- - ------------ - ----- Remodeling and/or repairing (describe):_- - - ------ -- ------- ----------•------------ -----•- ---- ------------------ ------ L --------------- aw { ---------------------- - I her that I have prepared this application an a�t�hLa o Heallbeth done{n ac r ante with San aaqum oun y ordinances. State la and rules and regulations of the San JdAq ------ ------(O r and/orContractor) ---- ------ (Owner C (Signe !) -(Title)- ------- By:-------- --------- ---- (Plot plan, shows sae of lot, location of system in relation +o wells, buildings, etc., can be pl ed on reverse side). FOR DEPARTMENT USE ONLY ff DATE h-_! ------- --------- APPLICATION ACCEPTED BY 1-- DATE----------------------------------------------------- REVIEWED ------ -- ----------------------- •--------•--- - --------------- REVIEWEDBY-------------------------------------------------- ------ - ------------ BUILDINGPERMIT ISSUED---------------------------------------- -------------------------------------- ------•---------------------•-------------------- ---------------- ------- ---- -------------------------------------- Alterations and/ar recommen a tons___________________ ___..___----_--_-- ---- -------------- --------------- - ---------------------- ------------------- -------------------- ---- ------------- ---- . ' ----- Date------ -- ` � --- -- i FINAL INSPECTION :--------- ------- - -------- ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 124 Sycamore Street 205 West 9th Street 1601 E.Hazelton Ave. 300 West Oak Street Lodi,California Manteca,California Tracy,California Stockton,California F.P.cc.