68-6 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. .Cl.- .__._ (Complete-in Duplicate) ----- -- ------ ----- - -- ---------- .......... Date Issued - -------------------- ---------------- ----------------- -------------- 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 ' all the work herein described. This application is made incompliance with Countyk0rdnangiNo. 549. JOB ADDRESS ANDL ATION. -- -- ------------- ---- -- ---------------------- ---------- Owner's Name -- - --- -----------�.. -- Phone4 ,r-6 F I Address -------------------------------------------;--- Contractor's Name-----VesidericeApartment --.-.-.-. Phone_dk61hQ7-_--. Installation will serve: House❑ Commercial E] Trailer Court ❑ Motel [jOther ❑ Number of living units: -1.---- Number of bedrooms Number of baths 1_- Lot size ----------------------- Water Supply: Public system ❑ Community system ❑ Private K Depth to Water Table W_ ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam p Clay ❑ Adobe IN Hardpan ❑ t Previous Application Made: (If yes,date-....------,--.---- ) NoV New Construction: Yes ❑ NoX 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 from•,nearest well....q.O.....Distance from foundation-- Q-.------Material -- -- --------- ---------- - -r------. No. of compartments--._.- Ei •.--.--.-_-Size--3-A.."x-9-----Liquid depth��Z-.��_ .-__-_-_Capacity.-51962------- Disposal Field: Distance from near t well--W-------Distance from foundation---/ ..-----.-.Distance to nearest lot lin,---5'--.-.--. Number of lines-=- r -�_ d �-- Length of each line.. --- -7�--.-.Width of trench... --- .----_�.- . Type of filter material--._. `�"�-' 5� _Depth of filter material---..-- ..-�-.-Total length-------------------�Q--------.�.-- i^ if Seepage Pit: Distance to neares well... ------Distance om ndation---14�_--_.Distan�re to nearest lot line-- �-- Ql ....-.--Linin material --- 33---_-_------De th_- --F-7- --- (� Nurrlber of pits.-. �I�. g ..-- Size: Diameter.-. r p 4 Cesspool: Distance from'hearest weii ----------------Distance from foundation_-_ __-_-_-____-_ - Lining material------------------------------------- El ,, Size:-Diamete r_- "-------- --- ----------------Depth---------------------------------`•----------------Liquid Capacity - -----gals. �. Privy: Distance * from well -..----.-__------- -----------_---.------ -Dis#ante from nearest building.-------------------------------------- ❑ Distance to nearest lot li `-----------------------------------.--------------------- Remodeling and/or"repairing describe):------ ------ - - -- -- - --------• --- ------ - --- -- ------- ------------------ -------- - -- ----- --- ---- ---------- -------------- ------ - -------------- ---- -------- - ------------- -------- � -------------- ----- r I -- - - - ` - _ I hereby certify that a prepared this a lic tion and that,the wor ill be done in accordance with San Joaquin County ordinances, State laws, d ru s and regulations t e San Joaquin Loca ealth District. , (Signed)---------------------- -- caner and/or Contractor] By: '------- ---- - - - - -1 --------------- (Plot -----(Piot plan, showing size of Iot, location of system in relati to wells, buildings, etc., can be placed6A reverse side). t y DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- - -------------- 3--- -( ------------'---------------- - -- ---- -- - ---------- ---------------------------------- -- REVIEWEDBY-------- '- . - ----- --------- ------------------------------------ --------- DATE----------------- --------------------------------- BUILDING PERMIT ISSUED-------- �--------------------------- ------------- ------------------ ------------------------- DATE---------------------------- --------------------------------- Alterations and/or recommendations - -------------- i •-----------•-------------•------------•-------------------- i -------------------------------- -----•----- ---------- ----- -- ------------------------------------ ------------------ ---- -------------------------- - ------------ --- -------------- ------------------------ - ------ --- ------------- ---•---------- ' I t~ k FINAL INSPECTION BY:. - Date_ ----•------------- ------------------ I AQUIN LOCAL HEALTH DISTRICT 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 20.5 West 9th Street 3 Slocklon,California Lodi. California Manteca,California Tracy,California E.H.9 2M 1.67 VongUard Press 1 - .s r