8305 - Laserfiche WebLink

Home Browse Search

CATION FOR Permit No. _R SANITATION PERMIT S.3d 5 y� APPLI _._..-?-_....._•-.•_y.... (Complete in*Mplicate) Date Issued Applica--ion 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 Ordinance No. 549. ( --•---- `f T!C /CJ JOB ADDRESS AND LOCATION--_. -Fi� -.__W e/� G U•7�7_._-.---- .._. �y-- ----------------------••---- Owner's Name 114elvoe Lam- �. ------- .. `` -t/ PhA�- ---71.0.5------- ------------------•-- s� 3 -�°--?-T---------•--- `.�.---- Address--------------- e�.c�e. Contractor's Name------------------------•------- ...... A fi1------------------- - -•---- Phone.---•-------•---------------------- / Installation will serve: Residence,g Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __.1___ Number of bedrooms __Z._ Number of baths __I.._ Lot size -------------� __-__. .- Water Supply: Public system 14 Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe " Hardpan ❑ Previous Application Made: Yes ❑ No._ 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: Distance from nearest well------—-----Distance from foundation---` ---------- Material------ ____..______ No. of compartments.......--2-------------Size----3XQX_s3} Liquid de th.__.___-i-4....._____..Capacity ----_-_- Disposal Field: Distance from nearest well----�`"-..._Distance from foundation________�'o..__.Distance to nearest lot Number of lines_________ _____�...__..___-_.__Length of each line------------ 3fD.Width of trench-_--_____.__i`fir __.___._._ Type of filter material_S-Jy�C,An toepth of filter material--- ----- -------Total length_._...._.... 2_____ -_..- Seepage Pit: Distance to nearest well....``_^---------Distance romfoundation____to---.------.Distance to nearest lot line---- Number of pits........-}------------Lining material-_ n _.__._Size: Diameter.__._—:!4`_.4Depth__4_........................ t Cesspool: Distance from nearest well ___-------------Distance from foundation._.._-.._---------- Lining material----.------------------_- T11 ❑ Size: Diameter---- - -------------- ----------------Depth---------------------------- ----------- --•-------Liquid Capacity- --------------------------gals. 13\ Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------- •-----------. ❑ Distance to nearest lot line--------- -------------------------------------------------•-------------------------------------------------------------------------------- Remodeling and/or repairing (describe):---- ........ -------------------------•--...----------------------------------------------..------------------------------------------------------ '^ --------------------------------- ------------------------------ ----------•-------•-- ]� ----------------------- ---------------------------------------------------------------------------------------------------------------- ----------------- ---------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S ate laws, and rules and regulations of the San Joaquin Local Health District. ' ID Y f 'L == '� ------------------------------•----------------------------- ------(Owner and/or Contractor) (Signed).f . --------By:....------------------•-----------•----------------------------- ------------------- ---------------------------------•-----------(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 APPLICATION ACCEPTED BY-------------------- - ----------- --------------------- ------ DATE REVIEWED BY ------ ------- - •---- DATE_ , - 5 -------------- BUILDINGPERMIT ISSUED------------- --------------------- - -----------------------•------------------- DATE / Y, -- •--------- --- --- -- Alterations and/or recommendations:. - .... .....--: • -----•---�" ? .� ------- -------- -----------•--------------------------------------------------•--------••----------------------------...._._...---- = ------------------------------- ------�r----j----•------ --------------- ---•------------------------------- - ----- - r: � ` . t n ---- — FINAL 4NSPECTION BY: Ca-�'ry`"-- � f-�---------------- �r-.�• Date. SAN JOAQUIN LOCAL HEALTHfDISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street S+oak+on, California Lodi, California glen+ata, California Tracy, California t —9 545446 ATWOOP 4s T� _