6825 - Laserfiche WebLink

Home Browse Search

1Permit No. ---- ---- --- - - APPLICATI N FOR SANITATION PERMIT '(Complete in Duplicate) Date Issued .__ X1 3 Ad. pplica+ion is hereby made to the San'Joaquin Count Health District for a permit to construct and install the work herein describe This application is made in compliance � ------- ---------- LOCATION -------- LOCATI �----- ------ phone----------------------------------- JOB ADDRESS A2NcD Owner's Name-�!, -e-'�C rteG,•------------- --------- - ------------------------------------------------------------------•--- --------------------------------------••---- -----•-------------a---- ---- Phone----------------------------------- Address _.. Contractor's Name______ Installation will serve: Residence partment House ❑ Commercial ❑ Trailer Court Motel ❑ Other -- Lot size --------- '--------------••---------- Number of living units: __ --- Number of bedrooms 3--- Number of baths _ - \ {— ft Private �epth to Water TablcaV--'-!ft• Water Supply: Public system ❑ Community system ❑ ar❑ Cla Adobe p n ElCh arae+er of soil to a depth of 3 feet: Sand C] Gravel ❑ Sandy Loam ClayLoam ElY ❑ nstruction: Yes No %Previous Application Made: Yes E] _No Co ❑ TYPE OF iNSTALLATION�AND.SPECIFICATIONS: 1 ' > . (No septic tank`or cesspool permitted if public sewer is available within 200 feet.) '.Septi .Tank: Distance from nearesst wwell-----------------Distance from foundation__.---- -Materia-------------------------------- --------------- h No. of corrpartments�'� __Size------------- n----�' Liquid depth Ca acit isposal Field• Distance from nearest well _:--_: Distance ofeach line foundationWidth ofttre chest lot line----------------- Number of lines------` � 'r s Type of filter mafierial-`..__ . _ ---------Depth of filter material------------------..--.Total length------------------------------------- Type __. _. -- ------ ----- i76 --Distance to nearest lot line-_-_ %y Seepage Pit: Distance to nearest welL_-__-��_.�--------Distance m foun S zle:nDiameter-#-F- . Depth____. -------- _Linin material-__ -- - Number of pits_-_.._._�------ -� 9 -------------------------------- Cesspool: __ ing Distance from nearest well_-..--._--.-_-_-Distance from foundafiion---------- ------+Liquid Cat acit gals•Cesspool: r ❑ Size:Diameter------------------ ------ ------- Depth------------ --------------- ------- ------ ---- q Capacity -------------------•--•--- Distance from nearest well------------------- - -_--Distance from nearest building--------------------------- Privy: w - ----------------------------------- �.. -------------------------- ❑ Distance to nearest lot ine--------------------------------------- ------------ E Remodelin and/or repairing (descrii�e):---- -------------- ---------------------- ----------------------------- on I hereby cer+ify that l havelespandareduthis lations olication and that f the San Jaaqui hLocalkHeall#heQistr,c+� accordance with San Joaquin County ordinances, State I s, and ru 9 --------_ __---_-.(Owner and/or Contractor( 0 ----------------- (Signed) _: - --- - -- - - 'tl -------------- gY: (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed an reverse side. FOR DEPARTMENT USE ONLY ------ QATE__... APPLICATION ACCEPTED BY ;� • - -------------------------- BUILDING PERMIT ISSUED---------- --------------- -.. ---- ----------- ------------------- DATE REVIEWED BY--- --- ---- ------- ------------ ------ ------ -- ------ ------ �� f Altera#ions and/or recommendations: ------- ---------- -- - ---- ------ ----- -------- -------- --------•--•------------------------------------- Alterations ------••- -•------------------ - �.------------•------• ---•- ---------------------- - ----------------------- ---------- ------------ ----------------- ------- -----_..--,._ __________________ __(-.---- / / Q - ------------- ------------------------------ ------------------ ------- ---- ---•----- ------------------------------------- ------------------ -------------------------------- --------- ..-- ----------- --------------------- Date....Z-9----------- --�--- --�-------- ----------•---------- FINAL INSPECTION BY-------------- ------5---- - SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street 130 South American Street 300 West Oak Street Trac . California Lodi, California Manteca, California k Stockton, California (�/j J a C Y\r-r ,,Ie te ES--9-21A 14544G AYWDCIa /_ l - --