12385 - Laserfiche WebLink

Home Browse Search

FOR OFFICE E. Permit No. ... -��-¢ ,,• ;APPLICATION FOR SANITATION PERMIT _""""_-" (Complete in Duplicate) Date Issued __/.------ --6-�/ ------------ ---- ---- ------------ ,k y -' _ 'This Permit Expires 1 Year From'Date Issue it to construct and install the work herein described. Applica#ion is hereby made to the San Joaquin Local Health District for a perm This application is made in compliance with County Ordinance 549. ------------ ----------------- A .►r JOB ADDRESS AND L CATION_.''/A/�-------------------- 1 = on --- --- ---------------------------------- Owner's ----Owner s Name- � - - ----. •----- ...... Address-..-------•--------•- Phone.. _ ` --- Contractor's Name""_ " - - t 4 Motel ❑ Other ❑ Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ f-, •-�� Number of baths _�, 'Lo+ size .__-- • •-- ----- 'Number of living units: _ ---_--Number of bedrooms - Water Supply: Public system �ommunity system ❑ � Private ❑ Depth to Water Table5w_ ft. Gravel Sand Loam ❑ Clay Loam ❑ Clay ❑ Adobe®Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ 1 ❑ Y Previous A hca}ion Made: {If yes,date_"_. ) No ❑ New Construction: Yes,❑ No �HA/VA: Yes ❑ No 8/ PP� TYPE OF INSTALUATION AND SPECiFiCATIONS: ,r * [No septic nk.or cesspool permitted if.public sewer is evadable within 2'00-ie"t•)' is arik: D ante from nee st well__"_"-"_"_.__'- qun t r+ Distance from founds#ion____".""""-.--------Material------------------------------------------------- \ No- o comp tmer#s jize-",._."". �-4=-Liquid depth--•---- ----------------Capacity------------A-------- Il- Disposal Field: Distance�fra'm nearest wellC� Distarcefrmfoundation_' ; -----•--Distance #o nearest lot linef�_-"-.____.._. ` t �`:'A `--------------Widtl4<of,trench.-trench ` Number of lines.___.____•-/-------- ---- Leng#h of each line __ '� YP1 --------- -Depth th of filter material---- _- - Totsll.en9th------•---_----•-••--- `5� T 4e of filter matefial-__ s P t �F {.. i w See it7-Distance #o nearest well.-"------------------"Distance from foundation"__-__..._"_- Distance to nearh--- t line""._-"" """."- II!,r ~' t.Size: Diameter i✓'�:V!" Depth ---- --------------------"- QQ t' r Number of pits-------k--------------Lining ra"te'rial3__ "-- -- i is ti i l gals. �Cesspoo: Distance fro.m�neares# well_____________.._Distance.f.yrom foundation.._--_-�"__-��.Lignin 'maternal""."---------------=-------------•--- ,� De th ------------ _- L1quirJ Cap�aatY ❑ Size: Diameter-------------------------:---------- P - ., ' N � � ." ""-_-_""_"--_--",_-..:'Distance from-nearest bui d g"" -------- ----------_----------------- Distance' Privy: from nearest well` : :a > n.--�.- --- ---------------------------- lot ----- - ----------- Distance to nearest lot line" t--- ----- � . ❑ ------------------------ .,a �` a Remodeling and/or repairing 4decfi e --- ------------ -------------- ".... --- ----- .-""s-f�' + --------------------------•----------------••-------'""..'__..."_ _._ ----------"-----------------------____ y ` �'-------------^ ja rb4 F - ' _ '► 1 ---------------------- l. 1 ` ;; ' ounty ' -------'- -------------------------------=---------------------•------ ---- - I hereby 'fy that l have prepared this application and"that the work will be done in accordance wi#hkSeniJ'NX .. - }e aws and rule and regulations of the Sari Joaquin Local Health District. r 9� '-ordinances; t a. " ner and/or Con+ract r r By 1 ---------------- (Sige - --------[Title]-- -"- ------------------ -------- -------------- _ 4 (Piot plan, showing size of lot, location of system in elation wells, buildings, etc., can be placed on reverse Sidi). . r f FOR DEPARTMENT USE ONLY 1 12 fO I' ---- DATE----- - APPLICATION ACCEPTED BY" . �--------------- - DATE-------------------- " REVIEWED,BY = BUILDING�PERMIT ISSUED - ------------ ----------- aT I Alterations and/or recommeridations:_. .__.- - ------ L -- -- I -•--------------- -------- ---- ----------------------------------------------- ------------------------------------------------- �------ -•-- ----------- TION Date"-. G FINAL ENSPEC SAN JOAQ IN`{LOCAL HEALTH DISTRICT �` St 205 West 9th Street 300 Wert Oak 5►rte ee � 1R4,5`ycamore Street 130 South American Street - „ "''` * Tracy,California Lodi,California Manteca,"Californla- 5toekton,California + E9.9 pEV1960 a-BS F:P.C9.iM 6.69