10037 - Laserfiche WebLink

Home Browse Search

Y � APPLICATION FSANITATION PERMIT Permit No. (Complete in Duplica+e] '' y Date Issued V------- Application is hereby madeto the San Joaquin Health District for a permit to construct and install the work herein described. This application is made ,n.eompliancewith County Ordinance .No. 549. I. -�------ =��--�-=-------- =-�-----------•-----------------•--------------- JOB ADDRESS AND-LOCATION-___ - �__- H, I--------- Owner's --- Owner s Nam ------------ ------ --- --------------------- d Phone----• ------•------- -------------- - # Address---- ---- u � - =` g' � ------ ------ ---------------------------------------------------------------- Phone------------_-------- ---------------------------------------- Phone------------••-•-------• -------- Contractor s will ^ if-Tr, iyh'L if - Installation will serve:3 ResiUence.&J-, Apartment House ❑ Commercial ❑ Trailer Court ❑ motel ❑ Other 1f � Number of.livin units: 5+ i g ts: Number of bedrooms -------- Number of baths _______. Lot size ------------------------------------- Water Supply :Public system' Community system ❑- Private ❑w Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand . - Gravel ❑ Sandy Loa 0 Clay Loam ❑ Clay ❑ Adobe 2 Hardpan ❑ It Previous Application Made: Yes ❑ No New Construction: Yes:® No ❑ •FHA/VA: Yes ❑ No TYPE OF IN6LLATl�OWAND 4ECIFI6ATlONS: (No septic tank or`cEess p of"permitted.ifspublic sewer is available within 200 feet) Septic Tank: Distance fro mnearest well-r_�_ ' O'Distance from foundation --_------------- -Material___ -G No of compartments X �Size------ ----- depth -=---- -------------Capacity _ .-- y Liquid Dis osal,Fiel : Distance from nearest we1144 Distance from foundation-N___ Distance to nearest lot lin k P� h ,rs' /�. tOF I Number of line ----:____r--_- Len th of"each line----------------- Width of trench-____-- r._;____--__•-;---- Type of filter material ! -t4#t Depth of filter material__ __�_�____-_Total length_____________ i ------------ 1k Seepage Pit: w . Distan he to neo est well_______r."______-_Distance from foundation__ _ __Distance to nearest lot line---_------------ ts - ! ------Lining material-- :#---- Size: Diameter: Depth------------------ -------------- ❑ Number of pi I CesspboL Dis rice rom nearest ----------------D.istance from foundation_;_:____-------.___:Lining material-__--------.--______________-_______. Size Diameter____ = = ------------------ -------Depth----- ------Liquid.Capacity gals. d 000 Privy: Di�s't Ce from nearest well.---`--------------------------------------------Distance from nearest building-----------------------------------------" aDista ce ----=---- W_ .-:.. _., �,. .. ----------- A i to nearest"lot line._.:. ~ '= odeling and/or re ir�ing (desoribel'________ ___________ --------------n--- -- -------------------- ....-------....------- --------------� = ' - - ---- = ------ Rs � ------- ------------------------------------------------------------=----------------------- -------------------- ------------- I ---------------------------------------------------------- ------------------------------------------ -------------- --------------= `----- = =----------------------------------------- r ! I hereby; cer#ffy tha+,:l-havekprepared +his application and that the work will be done,in accordance with San Joaquin County ordinances, State la `s, and rules and re lations;of the San Joaquin Local Health District. (Owner and/or Contractor) -- ---------------------------------------------- ----- 5i ------------ (Signed) O ( 9 ]------- A t _ Title --------------_•-------------------------- = (Title) = {Plot plan, showing size of to , location of system fin relation to wells, buildings, etc., can be placed on reverse side]. I a� i fFOR DEPARTMENT USE ONLY �M APPLICATIONACCEPTED BY--- ------'------- -------- ------------------------------------------------------------------ DAT EC - -------•-•----------------------------------------- REVIEWED BY----------------�M---------- J DATE__2 ---------------•-------------------- BUILDING PERMIT f55UED__..-------�-,--�--------------- -----------------------------------------=------- •------------ DATE----ACA....•-------------- =---•------------------------- Iterations and/or.r "ommendations: _ ---cok------------ ---•--•-------------•-------- x3 )9 t?• p �b"C) �' -5----bam�e ------- ++ -xti"'r r'•-- la[rn -------------- )r -If •------------------------------ s� �►�v rdr '�f: !e T11 4 -------- -K" Tt le�c. r✓,S� �r�T'�Q l ---- '---------------------- -----------a_ l �- r FINAL INSPECTION BY: = Date---:--- -�V-_ _�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 ES-9--21x1 Revises 157 F.P.CO.