14864 - Laserfiche WebLink

Home Browse Search

rUKUFFICEUS " � � �`� ! --- --- .�-._ - APPLICATION FC)R SANITATION PERMlT Permit No. ..._......J..�_/_!._ (Complete in Duplicate) �� : This Permit'Ex ires 1 Year From Date Issued Date Issued .._..........` _ ^... A Application is hereby made to the San Joaquin Local Heal#h 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 AND LOCATION.._. 0r -•_____--_-- ----------------------------------------------------------------- Owner's Name1� &.E;e9,0"/-------------------------- -- Phone.lfQ,o. .� Address----•---•--------- f� T Contractor's Name-----'-----------•+ �1r.._ � 1= f.✓ � -r /�J(/[� Phone--/ .l9EiL�,`1... Installation will serve: Residence B' Apartmeni',Hduse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living' units: _ i f.___ Number of bedrooms _._ Number of baths .�..__ Lot size ... ... ...I...... .......X��?__-___.-------_•-- Water Supply: Public system ❑ - Community system ❑ Private Depth to Water Table -------- ft. Character of soil'to a depth of 3 feet: Sand ❑ 'Gravel [-] Sandy Loam ❑ Clay Loam [j Clay ❑ Adobe a Hardpan C]Previous Application Made: (If yes,date--------------' ) No � New Construction: Yes �No W FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance frorri nearest well.._�0?_-_._Distance from foundation----/Ap......Material.---C!C"c_--_.! 'r No. of compartments___ _ -----------Size.: ----V'_x2t"Liquid depth---------- Capacity Disposal Field: Distance frorn.nearest.well----6-0-!•._.Distance from foundation•---.Z-0--.1---.Distance to nearest lot line-__-_�--- ® Number of lines:___.;_____-�y---------------__•_Length of each line---7..0. _ -9110-.Width of trench------------- S!t.a-____-•-•--_ Type of filter material._.. OCi :_.........Distance of filter material---_--r$"-----Total length...-_------_mss m,,--_-___-•---_- 1 Seepage Pit: Distance to nearest well - '-_Distance from foundation---.Tl,?._r..__.__.Distance to nearest lot line._:- Number of P Cesspool: Distance from near'�--well---Linen g• material R.' Diameter____!3.3'.."_____..Depth..........r_��'______....__ vl m foundation--------------------Lining material------------------------------------- ❑ Size:•.Diameter-=------1-------------s---- --I---Depth.---•-----••----------•----------------------------Liquid Capacity----••-------•-------. .gals. Privy: Distasnce from nearest well---------------------- ----------------Distance from nearest buildin ❑ Distance to nearest'lot line----.--- -- g Remodeling and/or repairing describe):-,_--- � /c/.....Tkr.7 --&I------------•------- -- t . --- -----------------------------------•........ - -------•-------------------------------------------------------------------------•--------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laivs, and rules and regulations of,the San Joaquin Local Health District. . c (Signed)----: sP` t----- :=T.eW-C, ------------------------------------------------------(Owner and/or Contractor By:--------401.1 -------- -- ----------------------------------------------------- ------:..(r+lel-----=--------------------------------- ---- - - - -(Plot plan, showing size of Io+, location of4ystern ,in relation to wells, buildings, etc., can be placed on reverse side). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ - - DATE -----•--•-- REVIE=WED BY----------------- - ------------------------- ---------- DATE.. BUILDING•..PERMIT ISSUED................ - --- ---------••- D AT -------•-----•-- Alterations and/or recommerida+ions:.._..... ` -------------------------------------------------------- -------------------•-------------------••--- -------------- - } FINAL INSPECTION BY:.... ...:.........•--------. -------------- ----------- Date------ ----- ------ -1�''--=-•-------•- s i J SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California 'Lodi,California' Manteca,Collfornia Tracy,California Es 9 REVISEa B-B9 IIM 6-61 ATLAS -