10561 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued _ _" _� ---- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work heroin described. This application is made in compliance with County Ordinance No. 549. , 3-_--6------ f-4---------9---- -----------------------.-•---------•----•--- I JOB ADDRESS AN OCATION-----------------_.----- ..- } ''`` Phone-- Owner's Name-------- --- '� Kx+ -------- �1- �x Address------------------ ----------------- / --------------------------- } � --- Phone._. Contractor's Name----------------- ---- ------------ - -------------------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [3Other ❑ Number of living units: ___. --_ Nu ber of bedrooms Number of baths -1----- Lot size ---- 17� -----t �- ------------------------ Water Supply:SuPP Y I : Public system ommunity system ElPrivate E] Depth to Water Table qw-, ft. Character of soil to a depth of'3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe ardpan ❑-- Previous Application Made: Yes ❑ No New Construction: Yes ❑ No HA/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----------------- from foundation-------------------Material------------------------ ---.---..--.---.----_--.. o' of compartments--------------------------Size--------------------------------Liquid depth---------- --------------Capacity----------- D'is'p`o^/sal --.--____-----Distance from foundation--------------------Distance to nearest lot line------------------ iel Distance from nearest well- Number of lines-----------------------------------Length of each line------------------------------Width of french----------------------------------- i ` T ,pe-of filter material-------------------------Depth of filter material-----------------------Total length----------------------------------1----- , � ��Distance to nearest lot line_ Y ' _y -_Distance from foundafiion- A --------.. /- Seepage Pit- Distance to nearest well------ _ I Number of pits-_____ __ Lining material- Cesspool: - _--_Size: Diameter--- 3--. -------.De{�th_ -------------------- Cesspool: Distance from nearest well-----------------Distance from foundation------------ ----.Lining material------:-----------__--------_-------. F1 Size: Diameter---------------- --------------------Depth----------------------------------------------------Liquid Capacity-- ---------•--------- gals. Privy: Distance from nearest well-------------------_----------------------------Distance from nearest building----------------------------------------------- ❑ Distance to nearest lot IInE - ---------- L� F a /l ----- ---------------------------------- Remodeling and/or repairing (describe):-----------C.��C �^�=---- `�1� --------------`------------ ` -------------------------•------------------------------------------ ------------ - - -- - ----- --------------•-------•---------------------------------------------------------- ----------------------------------------------------------------------------- ------------------ I I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin uin Coun+ ordinances, State laws, an es and regul do s of the San Joaquin Local Health District. t (Signed)- - --�------------ --- ----- r- -- --------------- -- - ---- -- - -- - --- ---------- ----- (Owner and/or Contractor) -------------------------- --- - - - - {Title} -- (Plot plan, showing siz ot, loca+i of system in relation to wells, buildin can be placed on reverse side). i FOR DEPARTMENT USE ONLY a � .._.:.�� --------------- T '--2----/----S APPLICATION ACCEPTED BY---- • - ------------------- DATE -� REVIEWEDBY---------------------------------- ------------------------------------ DATE------------------------------------•----------------------- ( BUILDING PERMIT ISSUED------------------------- - --------------------------•---------------------- ------ DATE------------------------------------------------------------- Alterations and/or recommendations---------------------- ------------ I ---------------- I - - -------- - -- 4 ------- --- ----=----- -- v ------------ -----------------------•---------------------------------------------- --------------'-1--------------- - ---------------- ---------------------- --------- ----------------- ---- 2�2 � 7 FINAL INSPECTION BY:.----- Date----- ---------•----------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Stree# 130 South American 5#res# 30D West Oak Street SManteca, California Tracy, California Stockton. California Lodi, California ES-9--2M Revised 1.57 FY.CO.