3627 - Laserfiche WebLink

Home Browse Search

ANITATION PERMIT Permit No. APPLICATION FOR'S °� 7 - I (Complete in Duplicate) Date'Issued'____ S- ' ;,,. Application is hereby made to the San Joaquin Local.Healt District for a permit to construct and install the work herein describe& This application is made in compliance with County Oedinddce No. 549. w I0� 11�11I► // II; �4 Y 4-- e_4.------1.��_ 1- - ----------- JOB ADDRESS A LOCATION._- .- -------'- - i - ----- Phone---�- ---- --- ----------------- A. - . ----- Owner's Name---------- - •---- (. /I�� jrn// �. 1�• -�-•- ----•--- .......... --------••--------•---•------••............... Address------- -• ------• - ----- • Contractor's Name--- ---------'-------------- -------------------------------• ------------------ _ Phone_..". Installation will serve: Residence [Apartment House ❑ Commercial ❑ Traiker Court ❑ Mo el ❑ Other (]` Number of living units: __�____ Number of bedrooms _X Number' aths ._.1__ Lot size _ -- --- ------------- ` Water Supply: Public system ED Community system ❑ Privat Depth to Water Table ___"_ _ ft. Character of soil to a depth of 3 feet: ' Sand Gravel Sand Loam /Clay Loam [I Clay E] Adobe Hardpan ❑ Previous Application Made: IYes ❑ No New Construction: IL No El TYPE -OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is i able within 200 feet.) SeAtic.T• nk: Distance from nearest well------------- Distance from aundation____________________Materlal__"-"_..___"__..___._____---------------------- r , Size !--,Liquid d th ------------------Capacity No. of compartments-------------- -------- q pp. p Y f 1 Distance to nearest ZTty1pe,__<5_-_.."_p Freld�: Distance from nearest well- . __---Distance from faun ation.___Dis osal+ 10 -.` Width of trench.----- _-P------------------- 1 Number;oz lines_"_._t_._" j__-__- .__Length of each line".__rim___ ,#-___. Type of filter materi6l � Depth of filter mat eiia�l ---- r_ --__."" Total ostance gtohnearesoine------------------ Diameter __ _____________ I�umber of Its_ Linin material-----------------------Sizn Seepage Pit: Distance to nearest well.________________ M 1 Distance from foundati) Diameter----------- ------------Depth--------------------------------- .1 ❑ p 9 ! Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_---___..___--.._---______--_-___-._ -----------Liquid Capacity--------------------------gals. ❑ Distance from nearest well------------------------rte---. ---------------------Dist Size: Diameter--------_-------------------- ----De th--------------------------- r. Priv � _ �a`nce from nearest building r ❑ - °-- - Distance to nearest of ine""..___"-._____"_____.-- ---------------------- --------------------------------- El ------------ �i t Re od ling and ar repairing (describe) ' -----------_ •-------------- -------•--------------------' ------------- 1 �` c I' c ----- ----------- ------------------- I hereby certify that I have prepared this application and that the work_y!ilI be done in accordance with San Joaquin County ordinances, Sta. la`wrs, and', rules and regulations of the San Joaquin Local'Health District. --4 (Signed).._ 1 - —---- � �l�a�-- -- � - ---- Owner and/or Contractor) I - -------------------------------------------Title ---------------------------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY REVIE ED BY ACCEPTED BY ---------------------------------------------------------- ------------------ DATE ------------------------------------------------- REVIEWED BY: DATE ------------------------- --------------------- BUILDING PERMIT ISSUED----... ------------------------------------ DATE---- --•------------------------------------------ -- Iterations and/�o recom dations:------------------------- -------- sem-----------------------•-----+-- -------------•------- / -4----�3-- s -------------------------------------------------------- -----•-------------------------------------------------"----------•--------- FINAL INSPECTION BY:-------------------------- - Date----- -------------------------- -----•--------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North '•C" Street 130 South American Street 300 West Oak Street Manteca, California Tracy, California Stockton, California Lodi, California 0 E5-9-2M 1e-52 Revised W-2100 + '