15190 - Laserfiche WebLink

Home Browse Search

FOR OFFIQE USE: ------ - ---_ . APPLICATION FOR SANITATION ON PERMIT Permit No. ._ _- .: C� .__ k T *_i ; (Complete in Duplicate) /I -- -- This Permit Ex fres 1 Year From Date Issued Date Issued _1 JI21?_` 4 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein describe This application is mad in compliance with County Ordinance No. 549. d 71, JOB ADDRESSCAT10N. ' � `� ___ Owner's Name------- -- Address , ---- - - �---------------- -- Phone.'-&-..._ ------•-------------------- -- --- ----- t Gti , Contractors Name ' p ,a�— � � :---- ...................... -- D = ----•--. Phone._,/7/2P- ___ _ o_ __.... _ Installation will serve: Residence Apartment House ❑ Commercial ❑ r//ler Court ❑ Motel ❑ Other ❑ Number of living units: .--_ Number of bedrooms c- Number of bathslgr/ - -- Lot size ----sat _,-.--•---••••--_-•--- •-___ __ Water Supply: system Publics m Community s ' Y ❑ CY stem Y ❑ Private Depth to Water Table- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeHardpan ❑ Previous Application Made: (If yes,date ------------------- f ----) No ❑ New Construction: Yes [I No FHA/VA: Yes El C]TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if pubsewer is available within 200 feet.) Septic Tank: Distance from nearest well -�_l-- Distance from -.--__- -• ------- -------- . founl - --• ---.Material-------No, of compartments_.- Size_ r��6 Liquid"depth--.-------= ace � , �f • C-a--p---a•c-i-t•y. 4 i. _.�0�DisField: Distance from nearest well�L -__----Distem _ ,- --,.Distance to nearest lot line.Number of linesLength of each line---c�-___------ } Width of trench.- - ••--- Type of filter material. - - - _-Depth of filter material- - + ''/ g ---- - ------Total �. eepage Pit: , _Di"stance to nearest well- QQ--- -----__Distance from foundation .Distance to nearest lot line.---_._ � Number of pit's- __-----------_-Lining material-_ -----__--Size: Diameter__. // I •� ��.--------Depth-----�-•�--=--•----•---• � � Cesspool: Distance from nearest well--- ..__Distance fr foundation--------------------Lining material-,------------------ 0 ❑ Size: Diameter--------------�--y---------------..Dept h...... ky Liquid Capacity-...--, ----- - ---- C -- --••---------- ------- -----•-----•-gals. Privy: Distance from nearest well------------------------- Distance from nearest building - i Distance to nearest lot fine--------------------------------- Remodeling and/or repairing (describe)------------- ----------,_� -----•- --•--------- - t� ------------------ lL . - - ---•------------- 4l---- ------ -••---•------------------ --------- ------•--- --- ,r F---•-------•-------------•---------------•------------•---------------------------------------------------------------------••-------••------ •---------•--•----------------••--•------------------------ t Thereby certify.that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St la s, and ul an regulations of he San Joaquin Local He th District. -- t t"+ F w (Signed) •• -------- ------ - r ; --- -- -� �--------------- -•----------- r Contractorl y Title J BY� - --- - --- ------- (Plot plan, showing size of lot, location of system in relatio o wells build! s;,etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.-----. � ------------ `--------- .- DATE---- REVIEWED BY------------------------- -- ---- -- DATE BUILDING PERMIT ISSUED. DATE- Alterations and/or rete mend'ations:----- ---- ----------- ----------------------------------------------------------- -----'------------- �j ---_•.----• - ---- ._..-- --- _- ---.- -- ....... ....... . .-. - - - - - -------- - � �r �. F -------••-•--------•-------•----------•------------------ --------------------- FINAL INSPECTION--- ------------------------- -- •---------------- Date---------------••----- ------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Witt Oak Street 144 Sycamore Street 305 Watt 91h Street Stockton,California Lodi,Calffo +tp Manteca,California Tracy,California