9712 - Laserfiche WebLink

Home Browse Search

VII !I 1r�/✓� � s APPLICATION FOR•SAaNITATION PERMIT Permit No. -- 1 3b { (Complete in Duplica+e) _ A Itcation is hereby made to the _ /��,• � Date issued7i1!- pp Y San Joaquin Local'Healfh District for a permit to construct and install the work herein described. This application is made.in compliance with County pridinance No. 549. D L,OCAT16NJ �/JOB _-_ Owner's Name_- y' ADDRESS -------------------- .:,. - --- ------ ► c Address a-. --------- Contractor's Name ----------- ------------------------------ - � ..,.`.'.""Phone.--* Installation will serve: Residence A artment House ❑ Commercial t Number of living units: __1_ k ❑ Trailer'Court ❑ otel [] Other ++ !- -- Number of bedrooms A Number of •aths --�___ Lot size ❑ f , - 1 Water Supply: Public;system PP Y� - •---- Y ❑" Community system ❑ private Depth to Water Table -__-___ ft. Character of soil to a depth of 3 feet: Sand , Gravel [❑ Sandy Loam ❑ Clay Loa ❑ cJayA�dobre Hard an Previous Application Made: Yes No'R/ ++� p ❑ ❑ L� New Co,struction: Yes e No ❑ FHA VA; Y TYPE OF INSTALLATION AND SPECIFICATIONS: FHA/Vi C7 -No ❑ (No septic iank'or`cesspool permi+ted f b�yc��s�ew�,e+r is available within 200 feetr) Septi ank: Distance from nearest'Ili', .-- ?" -,; Dista e�from ?undat�on_10---_.------_Mate ia#I No. of compartments-- ___-_- ----- ,_5i e. -- t--- __- K ` .Liquid eptly � AsF C - aCapacitY Dispas Field: •Distance from nearest w i-- -y.- ,. �/ (stance from foundation- _ p '' - Number of lines--------- neaces�lot3 n Dist e t -- ---- Length of each ine___-•__-- Type of filter mater id f regi epth of filters material,---- Seepage P Jam' Notal ength Pit: Distance to 'nearestwell- _Q_:-_ -Distance f oundation"'_ d' �Q f ---.-__-Dista in to barest lot line---_,!_ !'r Number of pits_--_Y-=__`--____-.___Lining material__ t i : Diameter-__� Cesspool: l---------- -.Depth_ ❑P Distance from nearest well----------------Distantce�from oundation_._-_________.-___.Lining material-______--_________ ,s Size.- Diameter--------------------------- ----------Depth---- - ------------------------------------• ------Liquid Capacity---- --------------•-------gals. ----------- Privy: Distance from nearest well__'-------------------- -• - - __ Distance from nearest buildin ❑ Distance to nearest lot-lire---- w:---=- -_,_, g -------------------------- ---- ---------- \ Remodeling and/or repairing (describe):---_------------------- ------ ------ { i _-_-•----•__-•--•_•__•__•-------••--•----------------------------------•-__•----_--•--_•-_. --------------------------------------------------- +- I hereb y c ertify hate! have•prepared this application and,tha+ ----- ------ ----- ordinances, State laws and rules and regulations of the San Joaquin Local Health eDi Eric}in accordance with San•Joaquin County (Signed 1 /� " �---------------- -------------------------------- (Owner and/or Contractor) 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_-_ 1 REVIEWED BY --- ----------------------------- -:rT ------------------- r -------------------------- ----------------------- DATE.-.... BUILDING PERMIT ISSUED - AlToraf de ------ DATE------.sand/or recomm ndatn _ ----------- --•--------------------- ------------ +W---s• �` --------- --•---- -•----- . FINAL INSPECTION BY:�_- - -.._� -- - � � ------------ -� ----- Date_._ ate- � - ---------------- ---------- �.. . _ s SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street Stockton, California Lodi, California - 814 North C„ S+rest Manteca, California Tracy, California ES-9-2M . Revises 1.57 F.P.CO.