21332 - Laserfiche WebLink

Home Browse Search

FOR OFFiQW QU E:,., Y ' _ik - ---------------- ------------------- --- ---------- Permit No. _F APPLICATION FOR SANITATION PERM _y` (Complete in Duplicate) Date Issued x - ___ _- _ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compii ce with County Ordinance No. 549. fo TC M 5'� JOB ADDRESS AND LOC ON .RN _... rT _ _ - Owner's Name--------------c .-------- --•----- --- ---------------------- ----------- -- Phone----•------------------------------- a 'iI- 299 -----------MTLjR---t--------------------------•---------•-------- •------------------ Address -RT5 -----3- ----- o ---- --- Phone----------------------------------- _ _____________------------------------------------------------------------- Contractors Name Installation will serve: Residence Apartment House ❑ Commercial E] Trailer Court ❑ Motel ❑ Other ElII 2 I a ' Number of living units: __1_ Number of bedrooms -..___- Number of baths Lot size - Water Supply: Public system ❑ Community system ❑ Private d Depth to Water Table /.-J- ft. Character of soil to a depth!Iof 3 feet: Sand �Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe,❑ Hardpan ❑ iE �!_New_Constru.ction;_-Yes ❑��No FHA/VA: Yes ❑__.No 1, ,�P,r.evious_Application.Made: hf yes date.,__,_,, _-- _1 1`1oK -_— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S�____Distanc from foundation__.�Q-__-----.Mated 4___CP1C-RCT __.-____. Septic nk: Distance;°from nearest well______ _ ._ No. of compartments---__ -------------- Liquid depth_.... ��------Capacity---�ZQP----• Disposal Field: Distance from nearest well_..-� ---._.Distance from foundation------ to nearest lot line�._S___--___. ------Length of each line----�QD---c----- .Width of trench-------iZ-�-------f----------- Number,;of lines--------- 1--------- ----- ,---- Type of;filter material__-D- :}�_._-.De th of filter material___.__ _--.,ry--Total length--------------- Q------------ -- p Seepage Pit: Distance to nearest well----_---_.-__._---___Distance from foundation--------------------Distance to nearest lot line----------------- ❑ Number,of pits----------------------Lining material -- ---- -----Size: Diameter------------------ ----Depth--------- -------------------- I - Cesspool: Distance from nearest well---------- ---Distance from foundation------------------- Lining material---------.---------------------•---- ❑ Size: Diameter------ ------------------------- -Depth--------- ------------------°---- -----------------Liquid Capacity-- -------------------------9 Priv Distance from nearest well___________------------------------------------ .-Distance from nearest building------------------------------- ------ -- y' --------------------- ❑ --------- - - Distance to nearest lot line._.___----------------------- ---------- - ------------------- --------------------------- --- - Remodeling and/or repairing (describe)---------------------------------- --------------•--- -- - ------------------------------------------------- -------------------------- -----------------------------------------------1�---------------------------I------- -------- -----------------------------•------•-•------------ --------------------------------------------------------------------------fh - a I hereby certifywshat I have prepared this application and that the work will be done in accordance with San Joaquin County rules a-d regulationc;of the San Joaquin Local Health District. ordinances, .I , y- ractor)(Owner and/or Cont (Signed)._ ✓ _ Tale Plo# Ian, showing size of lot, - ( p location of system in relation to wells, buildings, etc., can be placed on reverse side). ! FOR DEPARTMENT USE ONLY .r DATE-------- f� f� ^� -------------------- APPLICATION ACCEPTED BY---_-_---i--- -R-> '- DATE------- -------------------------------------------------- REVIE NG PERMIT ISSUED------------------ BY----------------- -- k ---- --------- DATE. ---------------------------- - ----------- ------------- D-- ---. ._ ------------------ : ------------------------------------- ------------------- ---------------- ----------------------------------------------------and/or recommendations:___---_------------------ -- --------------------------------------------------------------------------- --------------------------------------------- --- -------------------------------- ----- ------ - -------- -- �F .. ___. _______ ______________, -_-_-._.. _......___ ._.__.__._.___._. JJ FINAL INSP TION B r ----- - ----- -... Date r ji w SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Avw. 300 West Oak Street 124 Sycamore Street 205 West 9th Street c iP Lodi,California Manteca,California Tracy,California Stockton,California