SU0006003 - Laserfiche WebLink

Home Browse Search

I � LtCATION .FOR SANITATION PEFT P�e{mit No. -.- 1 (Complete in Duplicate) ^' cf� ,t i a eco---_-.- i Application is hereby.{made to the San Joaquin Local Health District for a permit to co struct an th or „ eyein ire scribed. ^ ' This application is made in compliance with County Ordinance No. _ I ' �? . - _ ley -- ....... 1 Phone LOCATION .�rll��---------- JOB 'AQQRE S AND. �' I ; `� Owner's Name :, Address-••-••••-- -•-----•• ---------------- ------- €- -- - -------------------------- ------•------ '-.......- Contractor's Name-.-? rf1�E- --------- vne---------------------- Installation will serve:;) Residence l Apartment. House .❑ Commercial ❑ Trailer Court [❑ Motel ❑ Other ❑ Number of livingunits: _--_ Number of bedrooms -- --- __ - Number of baths __- --- Lot size ___--_-_ t_ - ____ __ ________________ I Water Supply: .Public system Community system :❑ Private ❑ Depth to Water Table Nt Character of soil to a depth of 3 feet: Sand ❑ Graver❑ . Sandy Loam❑ Clay Loam ❑ Clay ❑ Adobe &-'H--ardpan ❑ Previous Application Made: Yes ❑ No gq-'O'New Construction: Yes ❑ No �FHA/VA: Yes 0 No [�J --- i TYPE. OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ep yTan D']s#ante from nearest well----------------., Distance from.foundation--------------------Material----------------------------•___________._-_•___- 44- No. of-compartments------------------------:_Size-.=-----------_-------------:.--Li Liquid de th---___-_-----___---- Capacity 0. q I? P tY - Numbeofol nesrarest-well--.--_------`_.;;;length of each {ine foundation..--,-------------- - -- --Widthcofttrench est lot line:.---_--.--.::--. y Dis Field: Distance T'pe of filter mafierial-_______________________Depth of filter material-_--.__.t-`_------f--To#al length._--_---__-___---___- -_--._____.---__---_ i __ Distance from fou ation___-I .. See a Pit: Distance to nearest we[{--��_:_: �_:.__-,pi to nearest lot line. - [ _ . ----De Depth ,%C `•----------• Number of pits-__-_-,�--__-_---__'Lining matercal� Size: Diameter--_- � p � } y Cesspool: Distance from nearest well-------------- ?_Distance from foundation------------------- Lining material-------------------------------------- Size: _--__-_----_------_- _------____--_. ; ---------------' - ---------------------------------Li Liquid Capacity --------gals. s ❑ -' p - Distance from nearest building_--Y_____--___--_-- Size: Diameter------------- Depth - _ _ _ Privy: Distance from nearest well--------------- ------- ---------------- ❑ ce:.to nearest lot line----- ------- ---' - Distance: g / ai Remode{in and/or repairing ring (describe): ------ RT ------------------------------------- ----•------------------------ ----------------------'---•---•---------------------------------------------------------------------------.------------------------------------- ------------------------------------ ------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------- ----------- I hereby certify that I have prepared Ais'application and that the work will be done.in accordance with San Joaquin County -.f ordinances, State law's, and rules and re ulations of tire`San Joaquin Local Health District. • ---------- (Signed) • 5 '��-_-- --_----_- Contractor] BY:-------------------------------- ------ ------•---------------------------------------- -------------- (Plot plan, showing size of , location of system in relation to wells, buildings, etc., can be placed o revers side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------------- - ---- -------=--- •----------•----•--•---------------.--._------- DATE... - ---------------------•---••-•------------..---- REVIEWED BY--------- � ------ =1,' DATE ------------------------------------------- BUILDING ----------------•-----•------------------ BUILDING PERMIT ISSUED--------------- ---------•- ---- DATE------ ---- -d... Alterations and/or recommendations--------- -------- -------------------------------------- ------ _ I ' - - = --------------- ------------------------------------------------------ -------------------------------•--------- ------------ ---------- t-��' -- - ----------- ------------------------ == , -1--- --- -------------------- 'y .0 i� - - -- - - -- - ------------------------•----- --- -------------------------------=----------- -------------------------------- -------- ----------------•---•--•------------------------ --•--•------•--------- ------------------------------------- --------------------•-------------------•-------------••-----•-- FINAL INSPECTION 1 BY.-- � ------------------i •----- Date------- { ------------------ gJ SAN JO AQUIN LOCAL HEALTH DISTRICT 60 South Americen�Street 300 West Oak Street' 132 Sycamore Street814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California' ES-9---2M Revises 1-57 F.P.CO-