19073 - Laserfiche WebLink

Home Browse Search

FOR OFFICE - �" c" / - �_-. -- --' Permit No. Fv' USE: ` APPLICATION FOR SANITATION PERMIT I [Comple+e in Duplicate) Date Issued ___ "-7��- G~� ! �� a This Permit Ex ires 1 Year From Date Issued on Is' �� Applicata i;hereby made to the San Joaquin Local Health District for a permit o construct and install the work herein described. This application is made in compliance with pl;,Odinan e No.�549. h� , °JOB ADDRESS AND OCAT ON____-- ---t----- ------ Phone-10 Owners Name_-__"" --r "- - � � AddressmF. ` '' --------- -- •----- on Contractor's 'Name_____________ � I .. it M el ❑ Other ❑ ill serve: Residence �partment House ❑ Commerual ❑ Trailer Court ❑ � InstallationNumb'er of living units:ll__/__ Number of bedrooms ___4"_ Number of baths _ _.._ Lot size ______ ._ --------------- ' 'II th to Water Table __...___ ft. Water Suppiy: Public system�l❑ Community system ❑ Private �6p Y ❑ Adobe❑ Hardpan � Character of soil to a depth of 3 feet: Sand ❑ Gravel [D Sandy Loam F1Clay Loam 2—Clay Previous Applica+ion Made: (`f yes,date___________ l No New Construction: Yes E] No [—FHA/VA: Yes El No TYPE OF INSTALLATION AND SPECIFICATIONS: (No s11 ptic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank;Distance from nearest well------ from foundation-_.__.""_._.-.""_.Materia4------------------------------------------------ p --Size--------------------------------Liquid depth Capacity ------ i No. of compartments------------------- ' -2 -r—'___".Distance to nearest lot ki e___ ____-__. Disposal ld: Distance from nearest well_.t��_-----Distance from found X_ - , Width of trench---- A?; _.- Len th of each line- Number of lines______________ - --------- 9 Type of filter material__ -Depth of filter materiaL� - -- total length .1 =-- f II �-_ '/ I ion--_-,T,4 to nearest lot line�.��--------- Seepa Pit: Distance to nearest well_hD-- ------Distance fr foundation__ Depth -------------- Number of pits.__._.._-_�_..__..__Lining material_- � size: Diameter._ 'p° /// Cesspool: (from nearest well-----------------D'sstance from foundation---.---------------.Lining material------------------------- Liquid Capacity _ -____."_gals. ------------------------------------------------ q P Y ❑ Size: Dia'meter --.,Depth �s ante Distance from nearest buil ing_________________________________________ Privy: I� Distancel from nearest well-__------------------------ ---------------------------- - ----------------------------- ------------------- ❑ -"---------------- --------------------------- Distance�to nearest lot line_.___.-_.__. � I! Remodeling and/or repairinIg describe]:___" ------- _---7 "-.__------__"-------------- r, ._._ P'i �- -__-_"_______I________________ a ___--""._.___---"__-___--"---" _Ili."_c-____.__._._ _ ""_"_ _____ ____________ ___ al ]�- 'i =-------------------------------------------------------- hereby certify that I have prepared this application and°that the work will be done in accordance with San Joaquin County ¢^ aquin Local Health District. ordinance5� State laws, and:irul regulations of the San Jo - " .... ----------------------- I ner and/or Contractor) By.k ------- -----------------------------------------------(Title) ------- ---- - - ---------- [Signe - -------------- -----� -- ---- (Plot plan.,showing sixe'of at, location of sy em in rein+ion to wells, buildings, a+c., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICA ' DATE-------47-��4'4------------------------------ ��ION ACCEPTED i3Y_.-_- -"_"�� - -- -- PERMIT ISSUED DATE------------ DATE ---------- REVIEWEDBY DATE--------------------------------- -------------------------- Altera+ion ------------- -----------------------------------------• - Altera l's and/or recommendations:-------------------� ---- -- ------- � - ------ --- `�`'f�-f'1 - - ,�- �!' � � R .� /� �t 6 7-447 --------- ." � Date-------- --- - - ---✓- `f--------------------- - ----------------- - FINAL :......... ... - ----- ----------------------- INSPECTION BY -- -- �I SAN JOAQUIN LOCAL HEALTH DISTRICT j 1601 E.Hazelton Aw. 300 West Oak Street 124 Sycamore Street 205 West 9th Street ,y Manteca,California Tracy,California Stockton,California Lodi, California :E f.t=.co. ll it -