9172 - Laserfiche WebLink

Home Browse Search

f4 � APPLICATION FO...,,ANITATION PERMIT Permit No a. t .� Date Issued (Complete in Duplicate), �pplica+-ion is hereby made to the San Joaquin Local Health District for a permit o'construct and install the work hererlesceibed. This application is made in compliance with County Ordinance No. 549. - � o F JOB ADDRESS AND LOC TION-- --- --- --- f _ „. Owner's Nam -•---------•- - wry -------,- :-.� - -- -- --• ------------------- --------------------------.. Phone Phone ------ - ---' _--------- -� Address. .. + - ------- ... -- Contrac#ors Name. - - �.-�-F---- - -- --------•i------------•-•--------••-•------ Phone Installation will serve: Residences Apartment House ❑ ommercial ❑ Trailer Court ❑ Motel Other ❑ Number of living units: __/ -Number of-bedrooms__ Number of baths __/___ Lot size Water Supply: Public system Community system El 'Private ❑ Depth to Water Tab] ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel [:❑ Sandy Loam ❑ oam ❑' Clay LClay ❑ Adobe ` Hardpan ❑ Previous Application Made: Yes ❑ i No X New Construction: Yesg No, TYPE OF INSTALLATION AND SPECIFICATIONS: ��(No eptic tank or cesspool permitted if public sewer is available within 200 feet.) Y 4 S Tan : Distance from nearest well__-- .._-Distance from foundation____f�._-_-.Mater�al___ ------_- o. r mems_._ Size X - Liquid depth------ ,�.. ------Capacity-----rF--a r � j I Disposal Field: Distance from nearest well- _2 ----Distance from foundation .Distance to nearest lot line__.____.___ T` Number of lines------- ----------____-- ------Length of each line----` :f_--.------.-.Width of trench.-_,- - ----------------•_-..- 'o � Type of {filter material_. -------Depth of filter material___.1�__._.__ __.Total length___-___� Q ____________ ? Seepage Pit: Distance to nearest well_ �l_.----_--bistance from f lundat:or 0x. _Distance to nearest lot line...... _f._ number of-pits------1_____________Lining material,.- .....pl_"�- -i� Size: Dia eter_---X61-'----- ---.Depth...._ C .---•----------- .� f Cesspool: Distance from nearest well-----------------Distance from foundation-----.------.-------Lining material-_-_____--____.____--___.__---_____._. El Size. Diameter--------------------------------------Depth------------------------------------- 4 Liquid Capacity ---gals. Privy: Distance from nearest well-------.---------- -----------_-_----------------Distance from nearest building-----------_...-_ __ - r. 6 ❑ Distance to nearest lot line---- - - - �= �^ Remodeling and/or repairing (descriUe�rr, �QCJr� _ -- -- ---- r--- --�--- t �- -------------------------- ---------------------------------------------- � -----------------------------•----•---=------------------------------------ ---------------- --------------------------- -------------------------- --------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St to laws, andJrules and r ulations of the San Joaquin Local Health District. .4 (Signed)------.. . --- --- ? -------------------------------------------------------- ----(Owner and flr Contractor] • b • - - ----- ----- e�. ey �� f--------------------------• [rt{ �- (Plot plan, showing size of lot, location of.system in relation to wells, buildings, etc., can be plac�evers�i� FOR DEPARTMENT USE ONLY APPLICATION ACCEATED BY ------------------- ------------------------------ DATE------ REVIEWEDBY-------------------------- ----- ------------------------------- -- -- --------------------------------------------------- DATE }� BUILDING PERMIT ISSUED ------ DATE----- - ------------------------ Alterations and/or recommendations:----------- _-- --- ' '----------------------------- -------- s� u «1� -----••------- -.-__.__-_�_ _ _____ _______ - ___-- Y j� - } _ --------------- t ,elk = ___::= __ _ �... - ----- --- -------- . ----._....- V-7FINAL fNSPECTION BY -----`----- ---------- -------------------- Date �.-3.� 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 CS—3 iasaas aTwogo -