10551 - Laserfiche WebLink

Home Browse Search

!� Yrmit No.f Q - l--- APPLICATION FOR SANITATION PERMIT Pe (Complete in Duplicate) Date Issued Application is hereby made to the SanejoaquinLocal Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION_:-._�.-______-- - ,. { 111� - -------- Owners Name------ --------- ---------------- = Phone__ �- Address__ ��; l�ls�/----- w f r . one -. -,---- -- Contractor's Name.--- f«' -[J7sC f. ---------------------------------------=----------------0Ph Installation will serve: ,Residence [W Apartment House ElCommercial ❑ Trailer Court ❑: Mote,El Other ,,// ------'Y-�4 ----------------------- Number of living units: __�___ Number of be _4�-. Number of baths Lot size __ ____ { Water Supply: Public system Q' Community system 11 Private ❑ Depth to Water-Table'__ r Character of soil to a depth of 3 feet: Sand E3 Gravel ❑ Sandy,Loom El Clay Loam [3 Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No M" New Construction: Yes ❑ No [r/ PHA/VA: Yes ❑ Noe TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or`cesspool permitted if p=isfan er.is available within 200 feet.) Septic Tank- Distance from nearest well--- ce from foundation:----_ -.Materip--_�f - �- 1 of compartments------ L Size---44X�X Liquid depth- ---------Capacity--- ---- _w ° d ��'� ,,/4. f i isposal Field: Distance from nearest-wel�_---_Q�✓ Distance from foundation --___lO--�_--.Distance to nearest lot lig e -Len t.h .of each line- --- �Q------ --- -- Width of french------ ---- --------------------- --------- -------=--- `- Number of lines = 9 0 �r T e of filter material___. ��LC C_De Depth of filter material----.__le--------Total length_--__--_._l4------------------------- C -------- Type - - p - G� r lV�/If&._Distance from fou dation____-¢. istan eto neares�ot��e�L;----'-- Seepa e t:., ��D_' tajlGQ t nearest 1---- ------------ 7 G ❑ E NuA)et o A -----Lining material-------�.-Size: Diameter-_ .._ ;pt ih Ces❑spool: ba nearest well_--- ---- Distance from fou-ndation------------------- ni gmaterial---------------------------------- ------------------------------------- Size: Diameter -..---'----- Depth--------------------------------------------- Li dCapacity----------------------------gals. 'g------------------------------------------ Privy: stance from nearest well_-__-- ---- ------- - -- y,r ------ -------=-Distance from nearest building F1Distance to nearestlot line------ --------------- ----------------- ---------------------- -•-,_. :_.__.------------------------------------------------------ ` . - Remodeling and/or repairing (descri€�e):------------------------------ -----`------------------------- E --- --------- = I hereby er ' y that I have prepared this application and that the rlC will be done in accordance with San Joaquin County ordinances, tat la s, and rules a r ulations of the San Joaquin Loc Health District. ` --------------------(Owner and/or Contractors Title (Plot plan, showkng size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side}. FOR DEFA MENT USE ONLY APPLICATION ACCEPTED BY-- -- ---- DATE------ ---- - -- ------------ ---- --- -------------------------------------------- 131- REVIEWED BY-------------=------- ----- DATE---• ------- BUILDING PERMIT ISSUED--------- ----------- - ------ DATE------------- --------- ----------------- --------------- Alterations and/or recommendations----------------------- -----------------------•-------•---•-----------------•------------•---------------------------- ---------------- ------------------------ -- - -- - - -------------------------------- ----- ------ ---------------------- ------------ ----------------------------- -~�----------------- _ .�-----�--1--�_`------T�-�J--�-°'"fit---p�.e�.€�`�� ---C��r------------ -- ----- ----- ------ ----------- �"-- -- -� --------------------------------------------------------------------- ------------------------------- FINAL INSPECTION BY--------- ---- ----- Date---- A�._...�--------------------------------------- ------------------------- t � : SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Soo Wes+Oak Street 132 Sycamore Street $14 North "C" Street Staek+on, California Lodi California Manteca, California Tracy, California ES-9-2 K4 - Revised 1.57 F.P.CO.