19291 - Laserfiche WebLink

Home Browse Search

/ 7�rviyvr t U�t --- �j -------- ---------- APPLICATION FOR SAfNITATION PERMIT Permit No. -1.. . I1 (Complete in Duplicate) - --------------------------------------- ------------ - This Permit Ex ires 1 Year From Date Issued Date Issued .__ �p Application 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. iN f 7=70%W- 1717JOB ADDRESS ANDLOCA �.' `11'A/ R_ 21 AOddress__Name - i I'f 1� _. ' ------------- ----- ------ Phone__---------- I , " w Contractor's Name,----------- - ... Phone.. Installation will serve: ResidenceA artment House - p E]/' Commercial E] Trailer Court E] Motel [I Other El Number of living units, -A- Number of bedrooms S--- Number of baths_r___ Lot size ___L�fi�l�� _per---------------------------- Water Supply: Public system ❑ Commun3}y system, ❑ Private ❑ Depth to Water Table.Z.0- f Character of soil to-a- 3 feet: Sand ❑ Gravel E] Sandy Loam Clay Loam ❑ Clay E]� Adobe❑ Hardpan F]I k, f Previous Application Made: (If yes,date..............------) No � New Construction: Yes ❑ No ® FHA/VA: Yes ❑ No ®— y �+A•AND til .Ww.w.i tTYPE OF INSTALLATION ANDSPECIFICATIONS: % ` '(No septic tank or cesspool permitted if public sewer is available within 200 feet.)` .� Septic Tank: Distance from nearest weli__ 49----Distance from udation-- Q -..------Mate a�l- f� --------- ---- t f # -_,..---Capacty_No. of sLiqu•d depth ��il. Disposal field. p " Distance flrom nearest welL.W/10.--.--Distance from foundation_��_______�.Distance'to nearest-lot dine__-•"�_--- s [gam Number of lines___ Len th of each line_ _ -. - ��yy 9 �Q ��t1_...Width of trench ' ` .Type of i ter material �, +Depth of filter material__fr ___ --Total length_ 3 ----------------------------- Seepage _ _ __ _____________ ___See a e Pit: Distance $o nearest well- �Z�- ._Distance f 7 r m foundation_-11`40-----i-_.Dice to nearest lot Ii�rte ----• 0� Number of pits.....A-._____----_Lining material-_/ ---Size: Diameter' - ' ' I • - .€ Cesspool: Distance from nearest wel!________________Distance from foundation-.------------- material-_.__---...____._-__.___._,_____.__, 'I $ �. -� ❑ t Size: [}iometer -------------- Depth = ` Liquid CapacitY ---------------.gals. E Privy Distance ffom nearest well_--------------*__:_.___ .._---_.....Distance from nearest building I,El ,� 9 r Disfance fo nearest lot line---------- ---------------------------- _______ -------- _ ________________________________________ 4 Remodeling and/or repairing(describe):-----9__-_-------- ------------------------------------ ------- ------- ------------------------------- ---------------------------------------------•--- --------------------------------------- ---------------------------•------- - ---------------- ---------------------------------I---------------------------- --------------------------------------------- --------------------------------•---------------- -------------------------- - - I hereby certify that I have prepared this application and that the work will be.done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health Qistricf. (Signed) s ------------------ _`1` -----�� ------------------ -- ------------(Owner and/or Contractor) (PlotIan, showing size of lot,.I y (Title) -------- -- -------------- � BY'------------- ------------------ --------- , ( p g lotation of system in rel; ion to wells buildings, etc., can be placed on reverse side). uh FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY 1 •-•-••--•------ ------ DATE = r ', -------------------------- REVlEWED BY ------------------------ -------------------- ----------------------------- DATE------ BUILDING PERMIT ISSUED-----I-'-•----------- ------------------ -------- -------_----------------- ---------------- DATE---- Alterations and/or recommendations:__. _- � -_ .$'__- � ,/ ------ ------------------ ------ --------- ------------------------------------------------- --------------- ---------- a --------------------- -------------------- ------111' ----------------------------------------- ------------ ------------------ .. ... ----------------------- ---------- - --- ----- - ----- f a FINAL INSPECTION BY:-- -----.:_-- -- - Z�7_.6 (,-s -------- ------------ Date-- ---- ----------- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California i