8889 - Laserfiche WebLink

Home Browse Search

'] Permit No. ""-Q•A—---------- .. APPLICATION FOR SANITATION PERMIT (Complete in Duplicate)p ) Date Issued ---•-.F��_�_.. an t the SJoaquin Local Health District for a permit to construct and install the work herein described. } Applicakion is hereby made o e q This application is made in compliance with County Ordinance No. 549. ------••---------------------- ----- JOB ADDRESS AND C ION___-- -- ----- s Q� •------••- •- L/Y �G_�f C_.. _ Phone-----------------------•------------ Owners Name - ----- -------------- Address----•-;---•---- •---� ----- ------ ------------------ Phone i Contr`actor's Name-•--- ""_-- - Installation will serve: Residence Ftl Apartment House,g�_Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ---------------- -V-- umber of bedrooms __,7----Number of baths --_ -' t size __.__ --�`----�` '� a Number of living units: # Communit stem ❑ Private ❑ Depth to Water Table _�ft. .:Water Supply: Public system �-_ Y system Character of soil to a depth of 3 feet: Sand [I Gravel F1 Sandy Loam E] Clay Loam El Clay E] Adobe Hardpan F]Previous Application Made: Yes ❑ No ,a. New Construction: Yes ❑. No ,: TYPE. OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: -D'st nce from nearest-we}4 ---------------Distance from foundatyLn Liquid de th._Matarial__------_Capacity----------------------- F_ _____. __.__.___ "__. ❑ compartments_ ---.----Size----------------- q p• near Disposal Field: . Dis ante from nearest well-----------------DLenatce h ofreach linom e ation---. -------- -Distance t oftfrench est lot line._--- _:__=-:---: \ r ❑ er of lines. g Total length-- ---------------------------------- 71 r filter material------- ------- - ".. .__Depth of filter material_"______. ___ -- istance from foundation__/Q._ '__--..Distance to fearest lot line_-�---- Seepage Pit: Distance to nearest well__�GT}1LD p_ ,�ze: Diarrieter____." --ir-Depth_-v�L. ------------ Number of pits___ --------------Lining material__._ _ Cesspool: Distance from nearest we4------------------ from foundation---.------------------ Lining material-_-_______._--:____._____-._________ Size: Diameter--------------------- -------- ------Depth--------------------------------------- ----._____.L' uid Ca acitY---------•-----•---------•-- tN _ .. gals. ❑ --._Distance fronearest building---------- -'--•------------------------- Privy: Distance from nearest well__-_._._____ . 'lot i Distance to nearestine------------------------------------------------ Remodeling and/or repairing (describe)------------------------------------------------------------------------------------------------------ ----- -----------------------•---•-"--------••-------------------•-------•---------------------- r 4 hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat s, and rules and regulations of the San Joaquin Local Health District. (Owner and/or Contracto (Signed) ------- . --- --- ----- ------------------------- -------- ---- ---------�--------- - Sy:--. -------------- - --------{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 ---._ DATE-----� ------------- ----------------------------------- APPLICATION ACCEPTED BY------------------- ------- DATE_------------ --- - ----------------------------- REVIEWED BY -- DATE BUILDING PERMIT ISSUED-----------------_------------ ----- - --- -------------------------X-_-_-�4 Alterations and/or recommendations------------------- - ---------------------------- 4 . -- -- --- -�� ------ - •-------- --- Date---- ------- FINAL INSPECTION BY:... SAN JOAQUIN LOCAL HEALTH DISTRICT 132 S camore Street 814 North "C" Street 130 South American Street 300 West Oak Street y Lodi, California Manteca, California Tracy, California Stockton, California -, �� y. 14"46 nrwono