10304 - Laserfiche WebLink

Home Browse Search

APPLICATION-F,,OR' .-ANITATION PERMIT Permit No. (Complete •in,I)uplrcate]� * % ;;. k Date Issued v S Application is hereby madesto the San Joaquin Local Health District for a pe mit to construct and install the work herein described. �is application is,mam 'de in capliance-with County Ordinanc No, 549, 1 JOB ADDRESS ANQ.LOCATION ______...?d ____ __ ...... __� l_ - -------------------------------r--------- ---------- •-------- Owner's Na �Addre`ss__ _ Conttac or s Installation r Numb Water Suppl Character of Previous Ap TYPE OF It (No Ger)fic ,Tbnk Disposa Seepagg Pit: x Cesspool: Privy❑. ❑ . KLi _____6� I serve: Residence A rtment House ❑ Commerc r of living units: __r__ Number of bedrooms �_- Number Public system Community system ❑ Private ❑ ;oil to a depth ofA'feet: Sand ❑ Gravel ❑ Sandy Lc cation Made: Yes ❑ No��New Construction: Yes' Phone!'� �6 I y-------------- ------------------------------ gg �- -------------------------- Phone rl ❑t railer Court ❑ Motel EJ ,f bales --- /_ Lot size ]epth to Water Table ---ft, A( --L__ -,.w_ - m[:] Clay Loam ❑ Clay ❑ _ Ad No ❑ 4 FHA/VA: Y,es .❑ No ---- - ------------------------- Other ❑ Har1pan ❑ TALLATION AND SPECIFICATIONS: *s otic tank or' cesspool permitted if public sewer is available ithin 200 feet.) ,.i iY- Distance from nearest well_________________Distance from foundation_ -__11 ---------- Material___'__-------------- No. of;4om P Liquid depth Capacity-----------•--------- artments--------------------------Size----------------- Distance from. nearest well_________________ Distance from foundation ----------- '____'Distance to nearest 16t line ________.___..__. Number of lines ------------------------------ ----- Length of eacbIline-_ M--------------------r--_-Width of trench ---- •--- ........ x ------------- Type of filter material ------------------------- Depth of filter mate al ---------------- ateral_--------------- ----Total'length---.----------------------------1---�---- Distance to nearest welt �� __.Distance to nearest lot line.- -_9 -t��______Distance from f ndation__ ____________ _� --- I�IumE7er of�p Vis__ __ Lining „materia - __ ______ . -_ S;ize: biameter_--'-_______ Dep11h _1.�d �`�_____- I Distance from nearest well_________________ Distance from foundation -------------------- Lining material] -_____--____.._._______________. Size: Diameter -------- ----------------- --------- ....Depth-.-----_------------__ -_ - --------------------- Liquid Ca acitlals. Distance from nearest well ------------------- _:----------------------------- Distance from nearest bui{ding----- I--------- I-------------------- ----- Distance to nearest lot line ______.___________r ___=_y __-'�_______._-_ �' ---------------------- --------------------- --- -- ----- Remodeiin d/or repairing (describe):__.____ - -------------------•-----------•------------- ------------------------------------=-= _____________________________.._-_____-----.._______-_-_-__-__________________ I hereby certify that I have pr pared thisappf ordinances,-5Ute lawW)arW rules 4Aa_egt lationv'o,, and that the r an Joao, oa in Lo �"`gy: - ----- ��.g --------------- 11 --------=(Plot plan, showi g izen of system in relation to wells, bui r _ter ---------- 7 s� --- -----------r,'------- - ---------------- ----------------------='----- -- -------------------------1 . +• #t y__ h. -------------------------------------------- - ------------------------------------• ork will'be done in accord"ince with San al Healtrs y frit,. J�- � F -- --- --------(Ow -----------------J----(Title} = y� ings; etc can be pr. on r4ei ------------ ---------- S ! aaquin C�oanty or Contractor) i ------------------------ FOR DEPARTMENT USE ONLY. APPLICATION ACCEPTED BY--------- `,= rr I -fir- ------ — -�'yo r�' DATE -----1- --1a REVIEWED BY--..---- J----------} f--- DATE --------------- ---- BUILDING PERMIT ISSUED ------------------------------------------------------------------ I ---------- I t--- DATE -- Alterations a d r `co end! L+Tion -- ,.or ------------ -•• • ��----------------•------------------------- ---------------------------------•-------------------------------------------------------------------------- •----•- ------------------------------ -------------•- -- - - i -------------------------------------------------------- FINAL INSPECTION BY: r---- ....Date - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES -9-2M , Revises 1.57 ERGO.