SU0006685 - Laserfiche WebLink

Home Browse Search

ruK urri�r u3r: I------- ------ - -------------- -- - -- --------------------- A(NCATION FOR SANITATION PMO) Permit No. ----------------------- .................. (Complete in Duplicate) Date Issued ---------------------- ------- -------------------- This Permit Expires 1 Year From Date Issued --- ----------- Application is hereby made to the San Joaquin Local Health District for a per c nst uct a,,d i I the w, A hereir)Ods This application is made in compliance with County Ordinance No. 549. JOB ADDRESS ANIbLOCAT N-.---/C"Z/ A D . ............ --- ---- ---------kWg_ _9� -------------------------- ------------------------------------------- Owner' m....... —� I I s N, Address........__:9- -------------- ------ --- Contractor ------------------- --- ... .... . ....... i:-- - ------------------------------------------------------------- ------------------------------------------------------------- L J., -- --- 's Nam -- ----- ...... ---------- Phone. _dh4l Installation will serve: Residence Fer Apartment House 0 ,Commercial railer P rai Court ❑ Motel ❑ Ot r El Number of living units: -------- Number of bedrooms --------- Number of the -------- Lot size ------------------ ------- Water Supply: Public system 0 Community system E] Private Number to Water Table -------- ft, Character of soil to a depth of I feet: Sa' nd E] Gravel E] 'Sandy Loarn:0 Clay Loam E] Clay F] Adobe 3-11ardpan E Previous Application Made: (If yes,date-- -- -- ----------) No ❑ New Con'struction: Yes 0 No �HA/VA: Yes ❑ No E] TYPE OF INSTALLATION AND: SPECIFICATIONS: (No septic tank or cesspool permitted if public seweit,is available within 200 feet.) Segrtfic Ta!jk 4 Distance from nearest well-----------------Disfance from foundation-_-_.__-.---_.-----Material---__--_._.---.-_---_.-_.__-_-__----------... 1411 aterial --------------------------------------------- 1411 No. of compartments-------------- --------.--Size--------------------------------Liquid' deptk ------------------------ Capacity----------------------- ?SOla '6d Distance from nearest well-4-ce-,-'Disfance from foundati -01................Distance to nearest lot line---- V5 t4W.....Width of 11-�--.-Deptk of filter mate,ial... Total length Number of lines-------Z Length of each line T-9 Type o' filter Se le Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line-_---.-.--_-.._.. I\;umber ine------------- Number of pits----------------------Lining material---------- ------------Size; Diameter------------------------Depth------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundati6n--------------------Lining material_...........----__.._---..__--_._.-. ❑ aterial............... ...------------------ ElSize: Diameter----- --------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy; Distance from nearest well............._._...._.___..___.___.___-._..___._Distance from nearest building--_---_________________.__.._._..___--- ' ❑ Distance uilding------------------------------------------ Distance to nearest lot fine--------------------------------- ----------- =------------------------------------•-------- Remodelin ----------------------I---------------------Remodeling and/or repairing (describe --- - ---------------- ... .. . ..... . i--------------------------------------------------------------------- ----------------------------------------------- ------------ �-------------------------------------------------------- ----------------------------------------------------------------- --------------------- -------------------------------------------------------- ------- ----- - :---------------------- ----------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will done4 in accordance with San Joaquin County ordinances, State laws, and rules and� regulations he San Joaq Local He District. ISigned)----- -- ----- - - -- ----- ------------- -------------------- BY:-------------------------------------- ------;-----------------------------------:------- - ---- ------------------------- ------- i le)------------------------------- --------- - -------- (Plot plan, showing size of lot1_16dation of system in relation wells, buildings, et ., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------ ---------------------------------------------------------------------- DATE-----------------7' REVIEWEDBY-------------------------------------- I------------------------- ---------------------------------------- DATE------------------------------------------ ----------------- BUILDING PERMIT ISSUED---------------- ,g ----------- DA-TE Alterations and/or recommendations: -- ----------- ----------- -- - ---------------------------- -41............------------ 5- -10 --------------- ------------------------------------ -f- ----- ----------------------------- --------�-e------- ------ ----- - -- ------1* --------- --- ------------------------ --- -------- --- -- ---------------------------------- -------------------------------------------------------------- ---------------------- ---------- ---------------— ------------------------- ............ ..........------------------------------------------------ -------------------------------------- -- ------------------------- FINALINSPECTION BY:..... ..... ---------- -------- ------------ Date--------. ZA��- ----- ------ -- --- -------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave. 3.00 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California