SU0007124 - Laserfiche WebLink

Home Browse Search

___ ---- '3d A!0�*\ICATION FOR SANITATION PM Permit No. - ------ ------ = (Complete in Duplicate) . This Permit Expires I Year From Date Issued Date lssued..__�._�: '.----- � Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AN LOCATION-----,_-- -- .......... -_:.- '----_!.__ -- 17. Owner's Name/ T - '_ .2:r:Phoney Address--------------------• - 4 ------------------------ ------------• -------_--------•---•/•----------=--------- Contractor's Name--------------- ;__!---- ----- ------- 1 - ---- -- ------- -- -----------. ------i-----------•--- Phone�_��!•`3/../�� f � ; Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Cwt- Motel ❑ Other ❑ Number of living units: __/ Number of bedrooms ____/ Number of baths __.Z Lot size __--�� Pi _________________________ .....� . Water Supply: Public system ❑ Community system ❑ Private M"15epth to Water Table Character of soil to a depth of;,3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑, Clay Loam 0 Clay.,[] Adobe(Hardpan ❑ O Previous Application Made v (If yes`ciclte, ---,---------1 No Dg-' New Construction: Yes ❑ No ❑ rHA/VA: Yes ❑ No ❑ 4 TYPE OF INSTALLATION AND 5P.ECIFICATIONS-j , (No septic tank or cesspool permitted f public sewer is available._wit bin 200 feet.) E Se tic T nk: Distance from nearest well__ .__Q_ __Qistance from foundation__. --®--___ _Material-_ .____.__€ _ _____ __________ No. of com artments- _ � Size AX-5-,___ Liquid de th__=. _ ....._...__. C!a acit 1?1© Disposal Field: Distance from nearest well_,,4 ------Distarice`'fi-om foundation__4?4.._-.....Distance to nearest lot line_.-- c of Typebof filter material ___ �Pr ._/ ..Depthhofffiltehmlateria -$...-__-__=otalthle gthc=__�_ ___.._!_______ ° Q[ Seepage Pit: _ Distance to.nearest weft- --_14--------- __ Distance f om foundation__ I - ,f __ _ ._ ____ ��__:___. stance to nearest lot line ------- - L ' Number of pits-------/-----------Lining material_�f�=Et_11 "-_:---Size: Diameter____&3 F� p - -----Depth - ----- r°i. Cesspool: Distance from nearest well-----------------Distance from foundation..------------.._._.Lining material-------------------------------- ❑ . Capacity �- � Size: Diameter:_ --•=. ---= - -- --------------------Dep{-h------- - ---------------------------------Li 9uid Ca P Y-- - -•------------------9als;;,, : Privy: Distance from nearest well -____.__--------------------------------------Distance from nearest building----------__----.-__.________..___.____-- �V ❑ Distance to nearest lot line------------------------------- ? ' _;�. � -------- ------ --- Remodelicg and/or repairing (describe): ------------•-•-------------------------•-----------------._.:: -------------•-----------------------•----------•---------------------------------------------------•--------•-------•----------------------•-•-----------'---=----------------------- -I r. ---_ :. 7 r" ----------------------------•-------------------_-••-----•••--------------•---------------•--------------------------------------------------•----.-----•-'------------------------ ----_____'_..___-.__.____...___ I hereby certify that I have prepared this application and that the work will be done in accordance4ith�San Joaquin County ordinances, Sf laws, and rules and gulations of then Joaquin Local Health District. (Signed).----- s wnei and/or Contractor) . ___ - - buildings, etc., can btee�laced on reverse'By:-------- ------ - -- �-- ---- ---- -------- ...... Plot plan, showingsize of lot, location of system to relation to s, verse;side. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ge > _ '------------------------------------ DATE--- REVIEWED ATE--REVIEWED BY--------------------------------------------------------------------------------------------------- ------------------- --- DATE------------------ ----------------------------------------. BUILDINGPERMIT ISSUED---------------------------=------------------------------------------------------------------------ DATE--------.----------------------------------------=---------- Alterations and/or recommendations:-------�---4a _ ----- ----- ---- FINAL INSPECTION BY:...... C/ Date �1 �� ----------------- - - --------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazetion Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy.California