9325 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR. SANITATION PERMIT / Permit No. __ -L_-:3 5 (Complete in Duplicate) --- A is hereby made to the San Joacquin Local Health District for a permit to cons Date issued This application is made in compliance with County Ordinance No. 549, truct and in ail the work herein de cribed. JOB ADDRESS AND LOCATION"" °�- .,e -------_ Owner's Name �eu t..! hAddress ¢ one ' Contractor's Name ------------------------_ -------------------------- - Installation will'is"erve: Residence ---------------------------------------�--- ------------------------------------------------ = Phone. Apartment House ❑ Commercial ey� Number of living units: _" "__- Number of bedrooms " ❑ Trailer Court ❑ Mol ❑ Other ❑ Water Supply: - Number of baths'"-/- Lot size PP Y� Public system ❑ Communit _____ ______ y system ❑ Private (�' Depth to Water Table ", d Character of soil to a depth of 3 feet: Sand / ft. Previous Application Made: Yes Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Cla ❑ No New Construction: Yes / ) y ❑ Adobe Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ❑ NOX FHA VA: Yes ❑ No IG' (No septic tank or'cesspool permitted if public sewer is available within 200 fee},) .. Se tic Tank: �d" Mat, i y p c2 ` Distance from nearest well__c�Q_-_"_Distance from foundation--" _-___ _� No. of Compartments "_--_- MatC_ "- s�ze__• "`_ _�" ---Liquid depth---- isposal Field: Distance from nearest,well-"_ � { � ----Ca acit ---_ __�_,_,, --_-.Distance from foundation___ ( p Y g�� - 1 Number of lines------------ ---"---- / Distance to nearest lot line_"-aZd ------- ---- - --- Length of each line- c5`4 ' '- Type of filter material_"-�..�__. ;�--.Width of trench- �___ rr � { _ Depth of filter material----- � ----------- Seepage --------- 1 Total length----•--•��--�----------------------- �' ! Distance to nearest well---�t: ----------Disfiance / )tt';_ • Number of its---' -//" fo ndation_c3D: ------D* tance'to nearest lot fine-�v% _ p er -------- ---Lining material--- Cess Cesspool: r _Size: Diameter-__--- - �- p Distance from nearest well-----------------Distance from foundation---___-_---___-__-".-Lining material--. ___as -- ,_ "_"_" ❑ Size: Diameter-__"_--__ ----------------------------Depth------------------------------------------ Liquid Capacif -----------* . Privy: Distance from nearest well---------------- -------------gafs. ❑ Distance to nearest loft line----__- --: ---- -------Distance from nearest- g --------------------------- Remodeling and/or repairing (describe)------ __-- -------- -------------- - ------------------------ -----• -- •------------------------- -------- -------------------------- - •----- -----------------------=---------------------- - ---- - --- --- I = ( ----=----------------------•------------------------- ----- _-". "•__-_-"_" ."__""""_"".--"_-""-_----•-•--i------------------------------------._--""__"---------------------F"-----------------------�----------------------------------------------- _-""_"-_"_- "_---_"•_- --_ ! hereby c rtify that l have prepared this application Na'----------------- es, that the work will be,done in accordance with San Jo ordinance$, at .laws, and r es and regulations of t e San�Joaquin Local Health pistrict• Joaquin County (Signed) %—, .�--_"-- - Y - F y� ---------------- -----•---------- gY=--------•---------•------- ----- 1.l r-- _%f _'� --- --- - �� ------------------------------------ - _ _Owner and/or Contractor) (Plot plan, showing size of tot, location of system in,rela{ion to wells, liuildin s ` " # -(Title}__---_ , ------------- --------------------------- ____ g , etc., can be placed an reverse side]. 1 FOR DEPARTMENT USE•ONLY APPLICATION ACCEPTED BY---------------- , REVIEWED BY DATE..-" ---------- --- ---------- ----- --- --- - ! BUILDING PERMIT ISSUED---•--- =--------------------- yL:� - DATE----�--- - `� Alterations and/or recommendations:----- - ---- -- ---- - --------------------------"------ " t. - ------ DATE---- r --- -- --------- ----------------- --------------------------------------- --------------------------- ,t ---------- :� ------------- - �" --- = --------- AL .INSPECTION BY: ��/4-- S ---- ----•-------- ---------- Date---- ----- ----- ---- = #�130 South American Street SAN JOAQUIN LOCAL HEALTH DISTRICT ' 300 West Oak Street � Stockton, CaliforniaLodi.,, 132 Sycamore Street 814 North "C" Street Lodi, California + MS. anteca, California '` + * Tracy, California 9-2M Revisea 1.57 F.P.Co.