8167 - Laserfiche WebLink

Home Browse Search

..'� -- APPLICATION FOR SANITATION MMIT Permit No. --/0/ (complete in Duplicate) Date issued ----- --?.�X/g Local Health District for a permit to construct and install the work herein described. Applica+ion is hereby made to the San Joaquin Lo 0 This application is made in compliance with County Ordinance No. 549. -T 0 TION. JOB ADDRESS A Phone------------------------------------ ---------------- Owner's Name----- --F44-- -------------- ------ ------------ ------------------------------------------------------------------------------------------------------- Plnone-,tre.� Address ......... --- --- ---------------------------------------- ------- Other Contractor's Name t House [I Commercial [I Trailer Court [I Motel KI installation will serve: Residence Apartment 4 - ths Lot size ❑ --------------------- Number of I'iving units; -/--- Number of bedrooms -A-�N.umber of ba Water Supply; 'Public systemA—Community system 11. Private F1 Depth to Water Table -- ------ ft. —Hardpan C] Character of sail to a depth of 3 feet: SandFj Gravel D Sandy Loam O Clay.Loam E] Clay [3 Adobej& Previous Applicatio I n Made; Yes 0 No3jr-. New Construction:. Yes,&,_No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: available within 200 feet.) (No septic tank or cesspool permitted if public sewer is a .1. 1 - le----- ---.Material----<f�e --�r Distance from nearest well- ,stance from foundation_-- -------------- -------------- -D Septic Tank:. we "A T, clepfh-��------------__.-Capacity-._ _-_-v ------ No. of cornpatfmenfs--c�7- ---------Size- - i 1v@IA4,7, —La-ADistance from foundation---44-�- ----:--Distance to nearest lot line-.-. --------- rn Distance from nearest e— Dis .......1�? ,Z_5;e---------------- posal Field: -Length of each line- o----------7 Width of french M- / Number of lines ------- --------------I---------- -K-Depth of filter -.....Total len.gfh K. Type of filter mat-.._.__. nearest lot line---45-- - f o f r-tdation'-s',0 De +'n = A---------------- Seepage Pit: Distance to nearest well--- ,OXZ,-Distance Num6er-of pits.----- ------Lining material` ---- Diametern. ;AZL------- ce from foundation___________________ Lining material--_--_-.__--------------- -------- Cesspool Distance frorn3 nearest well-----------------Disfan --Liquid Capacity----------------------------gals. Size: Diameter------------------------------- ------Depth.------------------------------------ ------------ ------------ 0 Distance from nearest building_____________---------------- ----------- Privy: Distance from nearest well----------------------------- ---------------- -- ---------- ------------------------------------ ------ - ---------------- - I to nearest lot line-------------------------:------------- ------------------------------ ------------------------------------- Remodeling ancl�or repairing (clescribe):-------------------------r---------------------------------------------------------- ------------------------I------------------------------------------ ---------------------------------------------------- ------------------------------------------------------------------------------------------------------- ----------------------------------.-----:----------------------- p --------------I---------------------------- --------------- -------------- -------------------------------------------------- ---------- C o u nty --------- -------- ----------------------------------fyA-I-have.i-p-repar-e-df-6-i-s application and-that the work will be done in accordance with San J.oaquin I hereby cert at �Iei and regulations of the San Joaquin Local Health District. ordinances, St aw and rules - -----------------------------------------------------------------(Owner and/or Contractor) ........... itle)------or--- ------------------------- --------- ------------ -------(Ti ---- --- --- - ------- BY c.. can be placed on reverse side] (plot plan, showing size o 10 cation of system in relation to wells, buildings, et FOR DEPARTMENT USE ONLY DATE--------'cc ------------ --------------------------------- APPLICATION --------------------I----------- APPLICATIONACCEPTED BY------------- ------------ ----- ------------7 -•------------------------------•---- REVIEWED DATE_. REVIEWEDBY--------- ---------------- ----- ---------------- --- ---- ------ DATE--------------- ----BUILDING PERMIT ISSUED------------------------------------------ -------------------------------------------------------- -----------I-------------------s------!" I- ----------------------- - ------------------------------------------ Alterations and/or recommendations:__-----______________________ -----------\,- -------------------- 7� , - r`---------•--------------------------------------------------------- L -------- ----------------/ ------------------------------ ------------------------------------------------------------------- -------------------------- -0- ------ ---------------------------------- ------------------- ---------------- ------------------------------- ------------------------------------ - ---------- ------------- -- ---------- ------ --------------- - --- ------ ---- ----------------------- k -------- ---- ----------- ----------------------------- ---- - ------------------ ---------------------- ------------------ --- -------------------- SAN INSPECTION BY:--- ----------------------- E--------------- Date—).0. ------ ------- ----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street 130 South American Street 300 West 08k Street Manteca, California Tracy, California Stockton, California Lodi, California EF- 9 145446