4395 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued Application is hereby made to the Son Joaquin Local Health District for a permit to construct and instal;the 'work herein described. 'sapplication is made in compliance with County Ordinanc No. 549. JOB ADDRESS AND I LOCATION i ------------------ -------- J ----------------- - -- --------------------- Owner's Name------------- ----------- Address--------------------- F1111W ------ --- -------- Phone-------------------------------- --------------------- -- -- - - - -- ---- ------------------------------------------- Contractor's Name______I--------------I--- -- •- ----- •--------------------------------------------------------------------1:--------------------- one------- .............. Installation will serve: Residence 0 Apa ' [-]ent House .10- Ej mmercial ❑ Trailer Court El Mofe � her Number of living units: Number of bedrooms -3.- Number of baths P--- Lot size I I Wafer Supply: Public system Community system ❑ Private [:] Depth to 4 f ry Wafer able A-4 Character of soil to a depth of 3 fg—ef: Sand E] Gravel E] Sandy Loam E] Clay Loaf,El Clay [❑ -Adob ar pan E] Previous Application'll.l.de. No XNew Construction: Ye No E] _% S)k TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tan or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: 4-Distance from rZearest well_________________Distance from foundation-----------I-------Maferia)------------------- A .1 ------------------- --------- El 4Nokof cam art ............. ------------Size------------------- -----------Liquid cle�jh--------------------------Capacity...... Disposal Field: Distance from 4earest well------- ----------Distarrqfrom foundation-----------1-______Distance to nearest lot line_______-❑ trench.-----------_-.- .., eNu T6,er 6-ir finles---------------- ------ --------- Length of each line---------------------- -------Width of ------------------- Type of filter material-------------- 77" eyr-*4'filfer material.-------------- -----..Total length------- D ............ --------- Seepage Pit: ',Distance to nearest well-. foundation___:_______.___ A- - It-Distance from Distance to nearest lot line_____.,- - ------ 0 Number of pits----------------------Liningimaferial-,---------------------Size: Diameter Cesspool: I I ---------- ------------Depth--------------------------------- Distance from nearest well___________ Distance from foundation------------ ---Lining material------ ........ I ----------------------- ❑ Size; Diamefer---------------------------------------Depth-------------------------------------------)__.Liquid Capacity--- f ------------------------gals. Privy: Distance from nearest well__._____�- ------ -------------------Distance from nearest building........ ------------------ Distance to nearest-,18-f line, _12_0----- ---------------------------------------------- Remodeling and/or repairing (describe)F -- ---I -------------------------------------------------------- .i ---------- -----------------------------I------------------------------- ------------------------------------------------------------- ------------------------------- ------------------------------------------------ ILI I ------- --------------------------- --------------------------- ----------1- - ----------------------------------il ;--------*----------------------------------*------------------------------ ----------------------------------------------------------------- --------------------------------11-------------------------------I—-------------------------------------------- ------------------------------------------------------------- I herebycerci fyLthat,I i have pre ared.-this-appli d h f4he work will be'done in accordance with San Joaquin County ordinances, Statei tion an f a ions�!514e San Joaquin Local Health District. laws, and rules and re f (Signed)....... .. C -----It _4_e_� Byj • 07_- -----------------------------------------------------.(Owner and/or Contractor) . I----------- X 4 -------------------------------------------------- " ----------i----------------------------------------------�Tifle)--------------------------- --- (Plot plan, showing size of lot. location of system �r-------------------------- _�fem in'relafion-to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY A - --- ------- ------------ ----------------- DATE------- REVIEWED BY - -------------- ------- Wr DATE-- ------ --- - - ------------------------------ ------------ BUILDING PERMIT ISSUED---------------- --------------- ---- --- -- ------------------------------------------------ DATE------ ------------------- Alterations and/or recom mendaf ions:.-.-------- ------- --- ------------------------------_________________________________________i.___________.- ------------------ I------------------------------------------------------------------------------ ------------------------------ ------------------I--------------- ------------------11---- -------------e�-----------P.11---------y------------------------------------------------------- ----------------------------------------------------------------_.- ---------------------------------I-----------------------------I------- -------------------------- --------------- ------------------------------ ...... -----------------------------iq---------------s-, -W-4-------------------------------------------------------------------------------------- - -------------------------------------------------- ----------------------------------------------------I---------------------- ----------------- FINAL INSPECTION BY:..... .. ----------- - --------------------------------------------- AN JOAQUIN LOCAL HEALTH DISTRICT 130 Soufh American Sheet 300 West Oak Stre� 132 Sycamore Sfreet 814 Norfh "C" Streef Sfockton, California !�'I Lodi, California Man+eca. California Tracy, California ES-9-2M 10-52 Revised W-MO