5966 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Per No. .__ _. 1� ell (Complete in Duplicate) " Date lssued ___�/sem Applica--ion is hereby made to the San Joaquin Local 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--""_._ Owner's Name_ -----------------------•---=----- -e ,i .. ___________________________ Address_. /`% Phon � -----_ , a Contractor's Name----------- ---------------- -•------ --- ---------------------------------------------------------- - � Phone Installation will serve: Residence [ partment Houseomrnercial ❑ Trailer Court ❑ Motel '-4 Number of living a+r�its� ,[--- Number of bedrooms .Number of baths "" ❑ Other ❑ 1 Lot size ---�--'�--I -CU- Water Supply: Public s.tern Iy� .x_ "---- ��, Community system ❑ Private p Depth to Water Table 3- f. Character of soil to a deptli`o 3 feet: 'Sand ❑ ravel ❑ Sandy Loam [] Clay Loam E] Clay ElAdobe • and Previous Application Made: Yes E] No New Construction: Yes ElNad pan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ■ (No septic tank or cesspool permnifted if.public'sewer is available within 200 feet.) f S�ptie Tank: Distance from nearest well_____: Distance from f ~ ndation_�- No. of compartments "" p CaAacity_ V-9--- --- Liquid depth__aS-g-fir Disposal Field: Distance from nearest wIllAff- _Distance from foundation._!"� :____.Distance to nearest lot line, ~ F — .r y Number of lines-----f_:--- ---Length of.each.Iine,/_,- !_ 7- - ' Width of trench.s _z- ---------- 4 Type of fitter material__ � :_---:/_ Depth ofXfer material-----/I-<i""-_"Total length_-_-- � Seepage Pit: Distance to nearest well /Eric/ _ _.Distance fr foundation" 2�,�.- -- stance to nearest lot line_____. ------- A Number of pits � _______ _Lining .material""-_".Size: Diameter:___ ' P Distance fro Depth_ --"_-- -_""--- m nearest well____________ _Distance from foundation_-. _ ___ ___ ___ -.Linin material__. __ __. Diameter Size. Dter :____ _-- _ : �n. p __�:-_ .� � --------- �) .�--------- Liquid_Capacity_ __.--..�slf-gals. - Privy: Distace~from nearest well__. _ .__ ',--Distance from❑ " ' nearest building gDistance'to nearest.lot ie ------ - 1, y --f.-------------- - 0 Remodeling and/or repairing (describe): } --- w -- - - ---------- k✓u� -------------•---•-•--•- -- ----- -- •--------------•-------------•-------- -•=- ` ------ r _ , ----•--•------------- �. -•----- herebrta�te*-laws,"and hat I have prepared this a lice+•on and +hat the --- -------------------------------- p" •" _______-___" " - " " h-"work will be done in accordance with San Joaquin County v, ordinances, p p pP# rules and ulations of t e San Joaquin Local Health District. ' q-r----------- (Signed)-----•-------- ------------------------------------------------ -- - + gY: ,-'------------•------- ----------------= = (Title) ! aniractor) i (Plot plan, showing size of,lot, location of system in relati to wells, buildings, e " ., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY______________ ---------------------------------------------------------- DATE- R REVIEWED BY ------------------------------ ---------------------- ---- �...... --------------------------- -------------------------------------- DATE__. BUILDING PERMIT ISSUED------ --------------------------------- ------ DATE--------- -- -------- Altera+ions and/or.recommendations:____"_._____ r ..._.-----•----••---- =------ s " ------•----------- --------------------- --------------------------------- ------------------------------ _________________________ - _. r --------.________- _______ _"s_ __. 1 f FINAL INSPECTION BY:__." - -Date---` 02 /�� R ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street Sfockfon, California814 North "C" Street Lodi, California Manteca, California Tracy, California r ES-9-2M ; Revised W-2100