9263 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. ...... :3_ t,v� �` * ` (Complete in Duplicate) lily y bate IssuedAppliQe' is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. ,his application is made in compliance with County O�rdin�anc`e' No. 549. 'JOS ADDRESS ANQ LOCATION.. "----Q - ~`"""-`""'.---------------------------------------------==------------------•--------- •--------------------------------------- Owner's Name.. �q ------------------- ------- Phone Address.---------.. .2 `.:. r ------------------------- Co -----•--..-------•------ Contractor's Name —� -- ------�---• ----------------------------------- ------------------ ----- ---4-. Phone ---3�3 �S`---- Installation will serve: Residence �partment House ❑ Commercial ❑ Trailer' Court ❑ Moiej,❑ Other ❑ Number of living units: ---- Number, umber of bedrooms __9f_ Number of baths ._-/---_ Lot size .__ _ ______________________________,_ Water Supply: Public system Community system ❑ Private ❑. .DepW'to`Water Table �- ft- Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy#Loam E] Clay Loam ❑• Clay❑—Adobe[__f�ardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes,Rr--_�No :❑ TYPE OF INSTALLATION AND SPECIFICATIONS: t (No septic tank or cesspool permitted if public sewer is available within 200 feet.) , ' It W4F Septic Tank: Distance from nearest well-----------------Distance from foundation_______._._______.Material`._"� No. of compartments-. -- ---Size----------------------------=--Liquid depth ---------- - ------..Capacity-.---- ---- -------- Disposal Piel Distance from nearest well.................Distance from foundation_---_f:._- __`-_.-.Distance to nearest lot line_----_-•_---_.--- FNumber of lines-----;----------------------------Length of each line----------------- -------Width of trench--------------------------------.-- Type of filter material---- .- -_-Depth of filter material --.._._.____1_.-_---.Total length------------------------------------------ Seepagpit: Distance to nearest _-__..Distance from foundation_-j-B-,"._._----.Distan�g to nearest lot line--- Number. of pits......}.......... Lining materialSize: Diameter.-----,36-----------Depth------ 10__� ____________ 1� Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material---------------.--------------------- - El Size: Diameter-------------------------------------Depth--------- -------- ----------------- --------Liquid Capacity_-------------------------gals. d � r'rivy Distance from nearest well______________ ----__ -. :_.......... ....Distance from nearest building--..___-___---..----.__-__-_----.-._--.__ ❑ Distance to nearest lot line----------------------------------------------- ---- ------- --------------------------------------------------------------------------------- Remodelin d/or r pairing (describe)--------- ---- -- --- . ------- ---------=' ---------------------•-------- •--•• -•lam ----------------------------- ----------------------------------------------- ----------------- •- ---- -------------- -------------------------------------------•------ I herebycertify that I have prepared this application and that the work will be done in accordance with San Joaquin County' 4Y f Y P P Pp ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. - --- - :----------- (Signed}--?sowing ---------------------------- ------------------------------- ------ --------- -- --------(Owner and/or Contractor) B ------� - Plot lansize of t, location of s stem.in relation to wells buildings, etc., can bele)laced on reverse si a FOR DEPARTMENT USE ONLY _ I APPLICATION ACCEPTED BY---------------------------- ----- --- ---------•------------------------------------- DATE-•-------------- { REVIEWEDBY--------------------------------- ----- -------- ------- ----------------------------- ------------------ -------- DATE-------------- - • = -- BUILDING PERMIT ISSUED---------------------- ----- - ---... DATE--------- Alterations and/or recommendations:.------- --------------------------------------------------------------------------------- ---------- -•---------_----------------------------- Q=tea ------ .-----•. ------ -------U rs xzi42,cg /JV--------- -------------------- :.. �?v�_ _4- -------- �_ ---------------------------------------------------------------- --------------- - --------------------------------- FINAL --------FINAL-INSPECTION BY:. 7, ....6a< Date--/4.�-_ f.S�.! SAN.JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wesf Oak Street 132 Sycamore Street 814 Norfh "C" Street Sock+on, California Lodi, California Manteca, California Tracy, California ES-9 WE446 ATWOCD