Laserfiche WebLink
II APPLICATION FOR ANITATION PERMIT Permit No. _ �_ ..... <br /> I� li <br /> D <br /> i <br /> C <br /> ( omplete n Duplicate)h; Date Issued <br /> A�plica son ss hereby ma e to e aryi IS n oca ea rsc+ or a permit to cons ruc an sn all the or eresn escrvbed. <br /> This application is made in compliance wit County Ordinance No. 544. <br /> iq- <br /> ` JOB ADDRES 5 <br /> �, <br /> �/ p} fj��(( I S LO ON--1 1,-- -s-I--- -_&k--.2 --f---`r- ----' "--�------------------------------------------•-------------- <br /> 1 SHIP!�/�� <br /> Owner's Nam' Phon 3 <br /> - ------ -- k.-4---f-..--- o <br /> r <br /> - ------------------------------------------------------------------------------------------ <br /> Contractor s k - ---------------- <br /> s -1 ' <br /> Address-_ <br /> ,Name-----t- Phon <br /> Installation will serve: Residence [Apartment House E] Commercial E] Trailer Court Motel Other <br /> Number of living units: J----- Number of bedrooms -- Number of baths _' __._L-ot size ---..�.'���- ------- <br /> Water Supply: Public system ❑ Community system ❑ Private [►Depth to Water Table 4z5. ft. <br /> Character ofsoil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: Yes ❑ No V New Construction: Yes D?""No ❑ ' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> Se tic (Nokseptie tank or cesspool permitted if p�lic sewer is available within 200 feet.), <br /> p ` Distance from nearest welld°�s _f___Dista �e from f9undation--_+rQ._.___._..Materi h "`�` _-_-- ____-_ <br /> Il No. of compartments...__2-------------- ��`---- -------Li uid de th. __ '�. Capacity <br /> Size.. q p - ----- P Y <br /> f �___J--------.._.Distance to nearest lot li ------------- <br /> ne---- �j <br /> Disposal Fields: Distance from nearest well_so.......Distance from foundatio <br /> Number of lines------'----------------------------Length of each line--- 8--- al---.------'Width of trench-­ <br /> i-!) <br /> rench <br /> ppT <br /> ______-De Depth of filter material - ------------Total length----__________________ � <br /> Type of filter material__ti __._ p <br /> Seepag Pit Distance to nearest well. /"0-'Q------------Distance from foundation - "f�.i]istar:/e to nearest lot Ii e__ _-- <br /> i ; �_-__..Size: Diameter.__._. __. _ Depth____..s - <br /> Number of pits---_-t.__----.- --Lining material-_- `'' _.__ -- <br /> Cesspool: 1� Distance from nearest well-----------------Distance from foundation------------------".Lining material--------_---_-.---"___---.-.-_____-._ <br /> ❑ sl Size: Diameter"--------------- ------.Depth------------------------------- - -- <br /> ---------------Liquid Capacity------------•-----------_-gals. <br /> - - <br /> i� <br /> Privy: .:: Distance from nearest v✓ell--------_----------------------------- ---- --Distance from nearest building-----------------------------------------. <br /> ❑ Distance to nearest lot line------------------------------------- ---------------------------------------.---------------------- •------------- ------------ ------------- <br /> Remodeling-and/or <br /> ------------Remodeling'and/or repairing (describe) .. �.� '---ar t-' <br /> -- ------------ <br /> ---------------•------------- =----- <br /> ---------------------------------------------•-------------------- <br /> IF <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinarac State laws, and rules and regulations of the San Joaquin Local Health District. <br /> i (Signed - ------------------------------------------- {Owner and/or Contractor] <br /> Y ------------­-- t' - -------- --------------------------------------------------------(Title)- <br /> (Plot plan, showing size of location of system in relation to wells, buildings, etc., can be placed on reverA side <br /> k FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY DATE <br /> REVIEWED BY----- ---- -- DATE--- -"----"-----------------------------------•------- I <br /> --- -------- A— <br /> BUILDING PERMIT ISSUED---•---------- ----------------------------------------•---------------•---------- -----------------A DATE----- '--------- ------•--------- ------ <br /> I %, h - ______________ ____ <br /> and/or ,ecommend f ions:--------r-------------- - = �-/ <br /> Alterations �r -- <br /> �r <br /> ewe �� l 711..----- ---- <br /> f. II -------------• ------------ <br /> i --------- ---------- ----------- ---------------------- <br /> 'I ----------------------------------------- <br /> �� AJ / <br /> FINAL SPECTION BY --------- <br /> INbate <br /> �l SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 SStreet 300 West CA Street l32`Syeamore Street 814 North "C" Street <br /> outh American <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> F ! <br /> d <br /> ES-9 145446 alwgno <br />