SU0005702 - Laserfiche WebLink

Home Browse Search

AI CATION FOR SANITATION PERI, Permit No-:-.3J--w- ,:5— (Complete r(Complete in Duplicate) �� f Date Issued `_ V ,•:Application is hereby :made to the San Joaquin Local Health District for a perm t to co struct and install the work herein a�S�ribed. This application is made in compliance.with C unty Ord. . Nv 5 JOB ADDRESS AND LOCATION--- -- - ---- - -- ---------------•J-- Owner's Name------------------- -• --------• -----•---------.---------------- ---------•----------------- - - --------------------- Phone---------- Address......_.......... --------Address--•---_.------•-- - ----- --- ---. -.-: -------------------- -------------------- Contractor's Name . _ hone . ` Installation will serve: Residence ElApartment House E] 'Commercial ❑ Trailer Court ❑ Motel E] Other pig; Number of living units: -------- Number of'bedrooms - ----- Number.of baths ::46._ Lot size ---�---_ ___ Wafer.Supply: Publics system 0 ' Community system ❑ Private �epth to Water Table ________ ft. I - Character of soil fo a depthof 3;-feet Sand ❑ Gravel ❑ -Sandy Loam Clay Loam ❑ Clay o Adobe" arclpan ❑ 1 Previous Apirlicafion Made Yes ❑ No:",-�ew Construcfion: Yes No 0 TYPE-�O"t INSTALLATION AND SPECIFICATIONS: Adoo, `(114o3epttc tank or cesspool permitted if public sewer is available within 200 feet:) Sept— T k Distance from nearest.well_.-.._:- Distance from foundation _. _- .Material____ -__-__- � Na of compartmerafs--.- -- -- -Size --•----------- --Ltqu depth . Capacity (. Al Disposal • Id: Distance -from nearest ell___/_�a:__Distance from foundafi Dist; fo-nearest lof line �] ',S N�itttbei'.oi'lines__ ___ Length of each line___ .:--__-:Width of trench � _e +� w Te of filter, maferia_ � .___De---Depth of filter material____ Total' length----o�:- _ >Yl', p Seepag xD sNo nearesf well------------- - _-__Distance from foundation. Distance to nearest lot l:, rN p g _ Size `Diameter -.--• ------Depfh--------- Nu,"4'dr of ifs--- + ----------Linin material-_--_ r ------ Cesspool DIs ance;fibm nearest well _=Distance from foundation _ Lmmg material__ Ej. , Sizel Diameter -- Depth - -,.: ---------Liquid Capacity $ g' els. Privy: Disfance from nearest well._ _________________ ________________ Distance from nearest building ` ❑ s - --- :Disfance to nearest lot line--------------`- ------------------- ------- ^l Remo tng and/or rep ing [describe) ` --- ------- -- 5 y -_ --__ - - - __ ------------------- ___-_--__-____-___--_---.--_ --_ -___...._.___....__ __________________ -__ __ _ - I hereby certify that I have--prepared this application and that the work will be-done'in accordance vikk tah Joaqutti,county, ordinances, State laws, and rules and„requlafionsiof the San Joaquin Local Health'District. ,.; (Signed) .. � _. r /% onfra y - -- caner_and or Br----- ---(itis) - --------- -- ---- -------� (Plot plan, sho,iing size of lot, location of system in relation to wells, b.aildingS. efe.,-can be placed 'on.reverse side). . , r, FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------_ -------- - -- - - -----------------------------------------: DATE-- ---------------- REVIEWED ---_-`-- -- ------------------ DATE-------------,.-••-- - - REVIEWED BY--------------------------------- -------- _ x BUILDING PERMIT ISSUED------------------------ ------------------ ------- •• •-•..-- ---------------- DATE--------------= Alterations and/or recommendations_-------------------------------------------- _---------------------------------------•---------_------_----•-------=------- i i -------------------------------------------- --------------------------------------------------------•------------------------------------------------------------------------•------------------------•-•--- n FINAL INSPECTION BY--------------------------- Date - _ ----------------------------- SAN JOAQUIN LOCAL HEALTH .DISTRICT d 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C” Street Stockton, California Lodi, California - Manteca, California Tracy, California ES-9-2M !0-52 Revised W-2100