3214 - Laserfiche WebLink

Home Browse Search

No. -- --a- APPLICATION FOR SANITATION PERMIT Permit f [Complete in Duplicate) Date Issued 31- f Y 1a � � z — x, 10 J de t he San Joaquin Local Health District for a permit to construct and install the work herein described.Application is hereby ma This application is made in compliance with County ordinance No. 549. ` r /-- -- JOB ADDRESS AND LOCAT N.__-„ -- ------- ---------- ' ------------ ' � - ----- - Phone_,' - ---- ---- Owner's Name__ __ _--- Address----- --------•--------•--------------------------•-----------------•----------------------------•-------••--------------...---------- ------------- -- ----- -- 4 ---------------- Phone - ---" -� --- Contractor's Name---------- - --- ---- --•-------------- -- --------- ------------------------------------------------ a ' Commercial ❑ Trailer Cour} ❑ Motel ❑ Other installation will serve: Residence, Apartment'House ❑ Q �N /- Lot size --------------------- Number ; Number of living uni#s: __�__ Number of bedrooms. __ umber of baths __ _ i Water.Supply: Public system Community system ❑ Private ❑ Depth to Water Tab4� tt. Gravel ❑ Sandy Loam El Clay Loam ❑ Clay C1AdobeY Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Previous Application Made: Yes ❑ NoX New Construction: Yes N El T TYPE OF INSTALLATION AND SPECIFICATIONS: [No septic tank or cesspool permitted if public sewer is available within 24U feet.) _r Septic Tank:, Distance from nearest well_________________Distance from foundation______________.____.Material-_____________________________________________. Size x --=---Liquid depth----- ----------------- Capacity 11 Psy/�'�No. of compartments--------------------------4 Disposal Field! Distance from nearest well________________IDistance from foundation-________ ________D-istance-.to,nearest lo}sline_______._________ Number of lines------- ------- -----'-------------Length of each line-_--------------------Lv Width of trench__----------��---------- . -- �j- / /J' TYPe of filter material------------=-1-- -` epth of filter material------------------:•---Total I length------_----------- �---- --- - !j ___.Distance to nearest lot dine_- See age Pit: Distance to nearest well Distance fr fou tion___..__() -• ! Size: Diameter ��-- De th ------ -- -------- Pit. Number of pits-___I-_____________ ming material_ i 1" Dis#ante from foundation____________________Lining material_____-_______;I:___.________--------- esspool: Distance from nearest we1L __ -----gals. ----Depth-----------------------------------------------------Liquid Capacity. I ❑ Size: Diameter------------------------- ----- 4 Distance from nearest building------; II ------------------•-- Privy: Distance from nearest well-____--._____________-__ ,Distance to nearest lot ine------------- ---- -------------------- ------- - or repairing (describe): 1 Remodeli g arid/ P g } - - ---- ------- ------ ----- if # --- ,; County -------------------- - --• ------- ---------- -------------------.---------------------------------------------------------------------------- : I hereby certify that I have prepared this application and that +he work will be done to accordance with San J a q y ordinances, St ws, a ule and regulations of the San Joaquin Local Health District. [ 9 --------------------------------------------- --(Owner an r •� - [O d to Contras+or] Si ned -- (Title� - --- ---=------- BY o. �� --------------------------------------------- s [Mot plan, show ng size"'of;lot, location of system in relation to wells, building , a#c., can be placed on reverse si e). FOR R RTMENT USE NLY APPLICATION ACCEPTED BY___-_- --- :77 ------I---- . ----- DATE----- ----------------------- ------- REVIEWED BY------------------------------------------------------------------------------------------------------------------------------------------------- DATE DATE - BUILDING PERMIT ISSUED----------------------------------------------------------- ------------------- --------- --------- ----- -------- - ------------------- Alterations and/o- recommendations: n � -- --------------------------------------------------------------- ----------------------- ------- 1 ----'------------- Ere I JJILL -------- --------- -------- -------_- .-- ---------- ----------------_---- -- ----------------------- ------- -- J } ---------------------------------------.__------------- -------- ----'-------- < .,► ----------------- FINAL INSPECTION BY:----. ------ `= DateF--- SAN JOAQUIN LOCAL HEALTH DISTRICT 1 132 Sycamore Street 814 North 'IC" Street 130 South American Street 300 West Oak Street y Lodi, California Manteca, California Tracy, California Stockton, California ES-9-2M $-51 Revised W-2100