4362 - Laserfiche WebLink

Home Browse Search

' '- APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Permit No. -- - ....... Application is hereby made to the San Joaquin Local Health District fora er • Date Issued , - This application is made in compliance with County Ordinance No. 549, 14 p mit to construct and -� Date the work herein described. JOB ADDRESS AND LOCATIO _ -�- ._ Owner's Name---------- �------ - - -- --•----- -------------- Address --- -------•-•- 4Z•-�-P__ __ -cat �•-•yJ✓------------------------------------------ ------------ ..-._----- Phone ---- --�--------------- Address----- G --------•-------------•- � - Phone ----- 1lZl.� -•-----`-- Contractor's Name ams.----------- � ---•-•--------•- InstaRation will serve: Residence ----- --------------------------- ---------•-- -- Phone-----•-----•--------•-----•-------• Q Apartment House ❑ Commercial El -1._-- Number of bedrooms Trailer Court j] Motel ❑ Other Number of living units: _ Water Supply: Publics stem Number of baths Y ® Community system �-- Lot size ----- ------------------ ---- - ❑` Private El Depth to Water Table __ ft. Character of soil to a depth of 3 feet: Sand Previous Application Made: Yes El Gravel ❑ Sandy Loam ❑ Clay Loam New ❑ Clay ElAdobe Hardpan E] F TYPE OF INSTALLATION AND QICIFI�TIONS.Consfruction: Yes 4 N [] (No septic tank or cesspool permitted if public ser is available within 200 feet.] Septic Tank: -� i p Distance from nearest wall-_--- ell_Distance from oundation � No. of compartments.._-_--__ t f -e -------.Material--___ Size-- q . t _ Disposal Field: X- --Liquid depth-__---- __ p Distance from nearest well_._`-" Distance from foundation____- -----------Capacity__-_--g ® Number of lines---------------- /d/k�,w_Distance to nearest lot line___..,---�--� Lengths of each line-/-41teriP ---, ----.Width of trench-_-----�.?_4� -- Type of f"Ater material___- d?Q�[--_Depfih of filter materi ----- -------------------- Distance -� -. F ---f ------- -----V Seepage Pit; Distance to nearest well ____ � +1�--------�ofial length______-•-�__' ------Distance from foundation_______-__ ❑ Number of pits-,- _ Distance to nearesf lot line Cesspool: material--' Diameter___----- Cesspool: Distance from nearest well-----------------Dist`ance from foundation___________________ Lining material.------------------------------ Privy: Depth ❑ Size: Diameter-------------------------------------- Depth- -<--------------------------------- -- - - -- -- Distance from nearest well----- ----- ------Liquid Capacify-------------- ------------9als. Distance from nearesf buildingEl Distance to nearest lot line Remodelingand/or repairing (describe):---------------- 4. ------------------------- ----------------- ---- ------------- _ ---- --•--------------------••-----------•-----------------------------••--------- ---------------- ! hereby certify that I have prepared this application and That the work will be dans in accordance with San Jo ---------------------------------------- ------------------------------ ordinance , State laws, and rules -and•regulations of the San Joaquin Local Health District, aquin County (Signed). (Owner and/or Contractor) r --------- - (Title)------------------------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc,, can be placed on reverse sid r e). ' R b TMENT USE O_ NLY p APPLICATION ACCEPTED BY------- REVIEWEDBY------------------------------ -- ----- ----------- ----------------------- ---•DATE--------- ---- �- BUILDING PERMIT ISSUED ---------------------------- ---------------------- ------------•---- --------- DATE Alterations and/or recommendations:-•--- --- ATE__-------•----- -------- ----------------------- FINAL INSPECTION BY:-.------ ______________ - --------- � /? -j 7 c Date- ------------ --- - -- --------------------- AN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street Stockton, California Lodi, California 132 Sycamore Street 814 North "C" Street Manteca, California 1 ES-9-2M I0-52 Revised W-2100 Tracy, California