8897 - Laserfiche WebLink

Home Browse Search

�. cAPPLICATION FOR SANITATION PERMIT Permit (Complete in Duplicate). Date Issued ----- 'to Local Health District fQr a permit to construct and install the�work herein described. Applica+ion is hereby made to the San Joaquind 5-7 – Z7 3 This application is made in compliance with County Ordinance No. 549. f O� S (f Ltif IGc.��1 /" _ --_- � fps/ ------- --- - ti ,106 ADDRESS AND OCATION_ _.----_- - --- Phone-. i Owners Name.---- `-�- - ------------ -- --- - l_...__..� ----- - ---- Address--------------------------- on ---- Contractor's Name----------------- - - Installa}ion will serve: Residence Apartment House Commercial ❑ Trail r Court ❑ Motel ❑ Otheri❑ Number of living units: Number of bedroom _--_---. Number of baths _ _: _ Lot size ---- �3 ]�� - C ---•-------------- Wa}er Su 1 ' Public{ s stem Community system ❑ . Private ❑.�,Depth,to.Water-Table � ft. ; Pp Y• y l Character of sail }o a depth f 3 fee}: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes No ❑ . / TYPE OF INSTALLATION AND SPE (CATIONS:• (No septic tank or cesspool permitted if ubU-4-stance r is available within 200 feet.) j a e�i I_ t�tl fromu dOion__, - -:--- Se tic ank: Distance from nearest well :_-_-.- rn Liquid depth_- Capacity.. No, of compartments ize�r� f Di os I Field: Distance from nearest well_.-- -__.-._ - istance from foundat• ��---:-----Distance to nearest lot line��.---.---_.-- Len th of each line---, ----- t.Width of trench__- -` j g Number of lines----.,/ -- Total" length---- Type of filter material- ! epth of filter material - -- - —� –*•-- ' " t t� nearest I in --. ------- Se pa Pit: Distance to nearese _ istanc ,f f,+J ti --- Linin' maters - r1 Diameter .._ Depth- `s -------- - - --- C Humber of its.-.. g v -_--Li i id Capacity-__. ' i - '= - . . q p y s. Distance from nearest well------_____--___Det+hce from foundation............ .... Linin material-- - gals. Size: Diameter------ ------------------- P - ass oo Distance•from.nearest building--------------------------- P ❑ Distance from#nearest welL--------------'--=------------- } Privy: ------------------------------------ ---------- Distance ---------------- i ------------ - 1 '! ❑ Distance to nearest of line------------------------------------------------- � , ------------------- Remodelin and/or re airin [describe):-----•---- ----- ---------------------------------------•---•--------•---• -:.. --••---`--- -------------- l O g ----•------------•- •• P 9t l S ----•------- -----------------•-------- ' ------------- •------------ ---.------•--___•- --i- ------ ---- •-------•------' [ wo - -------'----------------- - - I hereb ify that I have preparedulat a PPI aha n an and a--h Local HealthleDi done n accordance with San Joaquin C my !q ordinances, ul a reg t '___ -_.(Ow r and/or Contractor) Signed ; { ---(T e_ - By:. ----------------- - (Plot plan, showing size of lot, location of system in relation,to s, buildings;etc., can be placed on reverse s1 e. ,.. FORDEPART� LY ----------------------- DATE------�--------------"--------------------------------- APPLICATION ACCEPTED BY ------------- ---------- ------- DATE--- ----------1 ------------------- -------------------- REVIEWED BY------------------ ------------------------- " - DATE-------------- - --•---- ---------- ------------------- -- - ---------------- •--------- --- y BUILD ING PERMIT ISSUED------------------------- �` o Alteration and/or recom ndatia t_-- -- -- r G S_ s – /1? - ---------•-------------------- -•-------- -------- -------- �1_r � I ----------- Date FINAL INSPECTION BY:-------.-G/� -- --------------------- ..------ ` �' F SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street 130 South American Street ° 360 West Oek Street. Tracy, California " Lodi, California ►ylanteca, California P Stockton, California ! `\ { 195446 ATWOOD 12-54 ES-9-2M