4567 - Laserfiche WebLink

Home Browse Search

Permit No. ___. _--- Lr APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued _ ----- 4 b made to the San Joaquin Local Health District for a permit to construct and install the work herein described. Application ss herey This application is made in compliance with County Ordinance No. 549. t� ?I ` 1 . "1 --_---- ----- ------ JOB ADDRESS AND LOCATION - ---- ------ Phone------------------------------------ . Name/' f-IPA -6..--- �/_/_��r�-1�1��/� _.. - �l --f�'----------------------------- Address - - Phone.. .-----� ---, - ° Contractor's Name--------------------------------- Installation Motel ❑ Other ❑ Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ � ---- Lot size ---- --------------------------- Number of living units: __1__. Number of bedrooms _ Dumber of baths _� Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table_ ft. Character of soil to a depth of 3 feet: Sand E] Gravel [I Sandy Loam [I Clay Loam [I Clay E] Adobe Hardpan E] Previous Application Made: Yes ❑ No 9 New Construction: Yes ❑ NoX TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 fee+.) Septic Tank: Distance from nearest well-----------------Distance from foundation__-----"""__""_--__.Material_.___..___"._ _______...._____---------------- -- .--Size--------------------------------Liquid depth---------- ----- ❑ No. of compartments------------ J,--_- Distance to nearest lot lin(_ Capacity. Disposal Field: Distance from nearest well_/�121yl�Distance from foundation____ --�� Width of trench."_ ---------------------- Number of iines______t ^ !P- -0-).._Length of each line__________ .�--- �� 1' e th of filter material----- __--� ------Total leng#h----�r-��--- Type of filter materiall_�._.t � p Seepage-Nf: Distance to nearest well----------------------Distance from foundation------------------.Distance to nearest lot ksne----------------- ❑ Number of pits----------------------Lining material---------------------- Size: Diameter-----------------------Dept'n--------------------------------- ce from foundation- Cesspool: Distance from nearest well-----------------Disfan ---------------- ningmaterial ❑ Size: Diameter------------- ------------Depth----•------•--------- ------ -------------------- Liquid Capacity_-------------------------gals. Privy: Distance from nearest well------ --------------------- ------------------Distance from nearest building--------------------------------- ----- _ _ _ - ` earest lot line________. ___. __"__..___.___ ----------------- ❑ Distance to n (� ----- Remodeling and/or repairing {describe):_..--- ------------- --•--------------------•--------------- --------------------------- ` J --------------------------------------------------- -------------------------------------------- I ��a 1 . ------ °•C " '° 'C "- ..+ �- -- --- - - -- -: -----------------------•-----•------------. ---------- --------- -- ---- I her ebyy r�ertify�-tlha#TI ave prepared this application and that the work will be done in accordance with San Joaquin County ordinances',Sta+e la s, an rules and regulations off the San Joaquin Local Health District. caner a or Contractor) ------- (Sign 1 47-----. `�- -------�----- • 'n relatio +o {Title) --- -- -- By:---------------•--- (Plot plan, showing size of lot, location of system i wells, buildings, etc., can be plat on reverse side]. FOR DEPARTMENT USE ONLY ✓-�., DATE-- �---+-3~5.3 APPLICATION�ACCE�PTEDY----- - -------- B -- ------- = ------ ----------------------------------- REVIEWEDBY---------------------------- ---- - - ----------- BUILDINGPERMIT ISSUED------------------------------------------- -- ------------------------------ Al+era+ions and/or recommendations:-------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------ ------------------------ --- ----------------- --------------------- ------------------ --------------------_--------------------------------- ------- // - --------------•------------ //FINAL INSPECTION BY:------------_____`._."-_.___-. --- ----- Date-- -- --------- ----- ---- ----------------------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North '•C'• Street 130 South American Street 300 West Oelc Street Tracy, California Stockton, California Lodi, California Manteca, California ES-9-2M 10-52 Revised W-2100