16296 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ---•• Permit No. J -. .. - ---- _------ APPLICATION FOR SANOATION PERMIT (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 permit to construct and install the work herein describe . This application is made in compliance w:lth County Ordinance No. 549. 40.E /s - JOB ADDRESS AND LO ATION_______ 4 -• Phone.....--_------•--•----- •- Owner's Name-------------- iJ_ ...----- � _ I__ .. A �- -----•-• 4?19 � ` i Address............................... � ._I ! --------------------------------- Contractor's -•---------------•--------------Contractor s Nama----------- �' -------- ------------ •---- ------•-=---�------------•-•--•-•-------••..... --------------- Phone �k ❑ Installation will serve: Residence O✓Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: ."-___ Number of bedrooms . _ _ . Number of baths - .____ Lot size -----•. Water Supply: Public system ❑ Community system ❑ Private JB-"Depth To Water Table -k- ft. Hard an Character of soil to a depth of 3 feet: Sand [Gravel ❑ ndy Loam❑ Clay Loam L] Clay❑ Adobe❑ ❑ i, o ❑ FHA/VA: Yes Na ❑ : Previous Application Made: (If yes,d6te________________---} No New Construction: Yes TYPE,OF INSTALLATION.AND SPECIFICATIONS- - I~- .. No se tic tank or cess oo) ermined if^'ublic sewer Is evadable within 200 feet. a Material---AF_Q-"- ---•- .. Septic T k: Distance from nearest well.-_��_._.._Distance from foundation...�__.._...... �_. � -, ---Size_ �p Liquid de th Capacityine No. of compartments_. p -- ••X- q P. LL - - f .17 Disposal Field: Distance fromineares�ell___ '�Distance from foundation.""ZQ to nearest lot l'�� Number of lines_---------_------- -- 40 ---Length of each�iine_ � / "1 .Width of trench---- f -...----•-•-----t-- 'Type of filtermaterial._. 1 �,K-----DePth of filter material__=-/ :=: �:.-._Total length---------------_---�'`'�Q Seepage Pit: Distance to nearest well_____________f Distance from foundation__..__..... -...Distance to nearest lot line----------------- 0 ❑ Depth------------- ---------•--.---- Number of pits---------------•------Lining material.. Diameter-----------••--"_"----- r �. e & ____________________Lining mate riel_____.____.______.____-.._____.___.- -.Cesspool: Distance from nearest well 5__ _ . DistancnA ` - oLiquid Capacity gals- Dep*❑ Size: Diameter--------^ --------- stanceJromnea.rest building---•----------------•--•--------•-----•--- PrivDistance from neas ., �,_ D� ❑ --------------------------------------------•----------- Distance to nearest,lot ling-------------------------------• - -------•- Remodeling and/or repairing (describe):_________________________ _ l-----•-- -•------------------------ -------------•----•-------- --------------- =-----•-------••-------"----------------•----.--"..-------------------------------- ------- )---------------------- -----------------------------•------•-••-----------•-------------------•-•--•--•------••----------------------- ------------------,----------•------<-------- 1 ------- -----�P--------`-_------,-_--•------------------------------------------------•------- - 1 hereby certify that 1 have prepared this a licatian and that the work will be done.in accordance with Sen Joaquin County ordinances, State laws, and rules and regulations of the' San Joaquin Local Health District. R;! t Owner and/or Contractor ( .. - - - --- ---- -- - ----- - { ) Signed) .r , i - - ... - = - _� — 8y;. --._ (Plot plan, showing size of lot, location ods em in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY '- DATE_ ` � ------------------------------- APPLICATION ACCEPTED BY-----_ :" .O. --------- -^ REVIEWEDBY------_----------------------•---------------------------------------------------------------_----- , PERMIT ISSUED----------------------------------- ------------ - - - - -----• -=-----_-- - DATE _ _ - AlFerations-and/orrecommendations:_=-f __/_-_ _-__/_ND1-"-7 --=-�� D_:5 ----Si OuJ!>1.�----- --i-- --�.::_-- : .._ � -----•----------------------------------------------------- -\' . r ,,,• i ______________________ ____________ __ ________ _____ ____ "_-. _ FINAL I % ---- / DateD SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street I 3o0 West Oak Street 144 sycamore Street 405 West 9th Street Manteca,California Tracy,California Lodi,California Stockton,California � 1Kr ES 9 REVISED 8.59 ZM 5-b2 ATLAS '`'