3679 - Laserfiche WebLink

Home Browse Search

1 t - 1 eb - APPLICATION FOR SANITATION PERMIT Permit No. _.7. -- V7 [Complete in Duplicate] t� Date Iss'ued 41i_k/53 App ication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work h This application is made in compliance with County Ordinance No. 549 erein described. JOB ADDRESS AND LOCATI _-----6/-- _- ------- Owner's Name-_,------- I� �.._.. . a:, d. - -��::.-- -- ----- ------------------ - Phone------------------------- -•----- Address---_---------------- = -r.�-- ---------- ---------- Contractor's -- - �� Contractor's Name---- ------ - -- --- Phone r - ,, �d Installation will server Residence/ Apartment House ❑ Commercial ❑ Trailer Court � Motel ❑ Other ❑ Number of living units: _/---- bar of bedrooms _- Number of baths f- - Lot size j----- Xf�' - --- ----- --------- Water Supply: Publi� system DKummuntfy system []Private "De fh to Water Tabl l Character of soil to a depth of 3 feet: Sand ❑ navel ❑ Sandy Loam ❑ ay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No New Cons+u�fion: Yes " No ❑ '} M TYPE OF INSTALLATION AND SPECIFICATIONS: :i {No septic tank or cesspool permitted if public sewer is available within 200 feet. 1 a4 Sept—ic�T-ank: - ,Dpstance from nebest well-_--------------Distance from foundation-_-_----.-------__. ,ateriaL--_-.---__-________..__-___------__---_- L�/� fro. of torr artmerats,.. . =_:=_R•.-.z� - W. _ -•-- G p. - -----------Capacity----------------------- Disposal p 1' �.��e`---_-• -�-- �- Liquid de th-----�--- - BGG - � Fi Distance from neares well-4----.___- stance from foundation-_- -_- ----Dystance to nearest lot line_-� ___---- ❑ Number 01 lines___-- _ _ Length of each line-----_ , (�_ __ Width of trench-_---- _ _____ ___________ Type of filter maferial-_S�_ �` -- -� ---" epfh of filter mat real___-- -- - _ -/--Taal length------- d--------------------/ Seepage P D.stanceto neares well�G---_ -_-----Distance fr fours tion _�1_----.Distance to nearest lot line---- _ _-_ umber o3, its--- • ' i .p• ____Linin material- ---__- ize: Diameter__-_ g z Depth-- } Cesspool: Distance from merest well-----------------Distance from foutdation__._'�__ .-_ -__.Lning material-_-___-_- ❑ Size: Diameter' ----------------------------Depth---------------------I-------- ---Li Capacity --------------------------gals. :T,: y Dlistance from ne{a-rest well i Priv isfance fF5TFrnearest building------------------------------ ❑ I istance to nearest lot line - t - ------------------------------------------- Remodeling and/or repairing fclescribe):_----- --•--------------------- # ---------------- 1 --------------- --------------•-•---- ---------------------•-------------- --------•----- t---- I hereby certify that I have. repared this"a�plication and that the work will be done in all with San Joaquin County ordinances, State la life, and rules -end,`re ° lations of the Sa Joaquin Local He th District, - r f I F, ' 01* (Signed)-------------- x --- f 4 f t ) =�' "��""� ��it"__------ --- Owne and/or/Contractor) Con ractor By:---------- ............ k� t ------------------------------ [Title)---- ----------------------- (Plot plan, showing size of iot, location o sy tem in relation to wells, buildings, etc., can be placed on reverse side). "''`""'�"�-� FOR DEPARTMENT U5E ONLY APPLICATION ACCEPTED BY --------------------------------- --------- --------- --- - ----------------------------------- DATE!-- REVIEWED BY -------------------------------------- DAT -- BUILDING PERMIT ISSUED------------- ------------- DATE----- -•Q--------- Alterations and/or r 9 nmmendatiSf rn" ._-n_ _== • :.:-_.I----------------------------------------------------------- ----------------- ---------- •------------ ,>- ---------------------------------------------------------- ---------------- -------•-•---------- --------------------------------------------------------- - FINAL INSPECTION BY:-------- lZ- -----------=------- Date_........ � SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street T 814 North "C" Street Stockfon, California Lodi, California Manteca, California Tracy, California ES-9-2M I0-52 Revised W-2100 �w