22570 - Laserfiche WebLink

Home Browse Search

----- --------..------- A � • tee . APPf_ICATIQN FOR SANITATION P . , t , HERMIT Permit No. .v�.................. -------------- -------- _ _ s (Complete int Duplicate) pate Issued This"Perritit Expires 1-Year-From`Date' Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein C, Z� This application is made inrcompliance with Count Ordinan e No. 549. , JOB AbDRESS AND LOCA I 'N__�� :- .M.-- ��- � �t>Sl�� '' . c�- -� - _ _,_ f Owner's Name - - P}�one------- -------------- 1 ____________ ___________ Address ------. Contractor's Name ------ V--------------•- �'= - ---- Phone..!- Installation will serve: Residence Apartment Housefl. Commer"al ❑ Trailer Court ❑ Motel ❑- Other ❑ -._ ;Number of living units:.__ ._ _ Nu .ber of bed rooms!f-�.- Number,of baths ___+__ Lot size -- t• Water Supply: Public system Commun t s stem 1— y y � ❑ Kiva to ❑De`ptii to 1Nater Table ------- ft f Character of soil to a depth of 3 feet- Sand'❑ Gravel ❑ Sandy Loam ❑ Clay Loam Ej—Ca _❑-+ Adobe n�ardpan F1 Previous Application Made: {If yes,date_-_- I No New Construction: Yes,[ , No-❑-❑ PAA-NA; Yes 0 No ® -- TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank or cesspool permitted if:public sewer is available within 200 feet.) � /") 6,,.,t-. 1No. of cam artmen s-__� dation.... __.____ - Ma�erial _-_ __ . _� ��r�. Se tic`Ta Distance from neares# �z'6i _ `10 Distance from foun l P � i Size_ ]C_ ... _ Liquid depth....j�/.3� Capacity_____-^ `C7----- Disposal d: Distance from nearest. weil._AI -4--Distance from foundation__`_ Distance to nee{es#lot lira__ , I�x Number of lines.-_-:riair w .... ____-_ t . Length of each line_f_. �! N r g ��t-:.- -.�-:..W�dth of trench--� ------•-------- -----•-- + Type of filter ma#e _�_ ---------------' Depth of filter material TM�f �TotaI`length -.'—! � s i Seepage s : Distance to neare w f - :_ _. ---a"D'istanc om f undat'ion_ ' ,.___.____._,_Dis.farice..to nearest lot Q Number of pits._ ` Lining material-- .(-�'- Size: Diameter.z �. h 3 -- Cesspool, Distance from nearest well ________________Distance from foundation----------_------ ..Lining material)_-.._}-____.______._,_ ❑ Size: Diameter_ __ __________ €� Depth Liquid Ca acit -----gals. + Privy: I Distance from nearest well'---f_----- ---- ------ .............t..... ._Distance from nearest building__._-.---.___.____._ ❑: Distance to nearest lot line -----------------•---------r�- R , - - ----------------------------•--------------------- iRemodeling and/or repairing �._ �C ' _. _ � ?G ---------- ---- 4 ------------- ----------------- ---------- d' - ----- ---- --------_- -----n - W. L- •----- ------------------ ----• ------ -------------------------------------------------------- =- ---------�------------------------ ------------ ---------------------------`-------------------------- ---- 1 �` I hereby certify that I have prepared this application rand that the work will be done in accordance with San Joaquin County r'dinances, State S, and r les.�nd regulations of the San Joaquin Local Health District, ' g ._:_.- �--�_- . - -(0' , er and/or Contractor) (y Y-•------- ----- �,.._i_ r� f_:. - = __.!_ Title . �` Nv 4�t: . �, ,�, 1 (Plot plan, showing size of lotA�c�-of-system in•.relatiori to-wells, buildings, etc.,,can-be laced on reverse side. � ) l -- --FOR DEPARTMENT USE ONLY - APPLICATION ACCEPTED BY- ) - VG'' -- DATE__fl--" ._!. '- ------------ ---- - REVIEWED .BY -------------------------------- .._-------------------- -------- - -------------------------------- ------ DATE C BUILDING PERMIT ISSUED---------- ------------------- ------------ DATE---- 1 Alterati s nd/or re en ations--- -- ----------- ---------------------------- ---- -------------------------------_ 7XV rf - -- --........ - ® i / v ----------- --- ------- ---- ----------- FINAL INSPECTION BY:. -C'` - Date SAN JOAQUIN LOCAL HEALTH DISTRICT/ w 1401 k.Hazelton Ave. 300 West Oak Street 124 Sycamore street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press r