2557 - Laserfiche WebLink

Home Browse Search

�L APPLICATION FOR SANITATION .PERMIT , Permit Noll�_ (Complete in Duplicate) .S �Y, Date Issued _-- 1__9-- --- Application is hereby made to the San Joaquin Local .Health District for a permit to construct nd install the work herein described. Thisapplication is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LQ ION--- -------- ------------------------------------------------------- Owner's Name � l• --- ----- - 4- ti ------------------------------------ ------------------------------------------------- Phone---- ---------------- Address----. —----------- -- --l'------------------------------------------------------------------------------------------------------------------------------------------------------ Contractor's Name------ ---------------------=------------------------ ------ ------ Phone--- In stallation hone_-Installation will serve: Residence Apartment House E❑ Commercial Trailer Court ❑ Motel ❑ Other ❑ 7 Number of living units: -------- Number of bedrooms -------- Number of baths _r�-- Lot size __ ® ® ----------------- Water Supply: . Public system ❑ Community system ❑ Privafek" Depth to Water Tablez, ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes E] No New Construction: YesAe No El TYPE TYPE OF INSTALLATION AND SPECIFICATIONS: t (No septic tank or cesspool permitted if public sewer is available within 200 feet.) V Septic Tank: Distance from nearest well 6 --_Distance from foundation�J�---------Maferi l___- %- --, ________ l X� X�L' - - a__ No. of compartments-__--�-------------Size__---__-__-___ __,__.___ squid depth___ ---�__-_Gapac+ty----._ - Disposal Field: Distance from nearest well------------------Distance from foundation--------------------Distance to nearest lot line----------------- E-1 Number of lines-----------------------------------Length of each line------------------------------Width of french----------------------------------- Type of filter. material-------------------/_.--Depth of filter material------_-_-----�- Total length----___-_ _________----___--------_-- _� 1 Seepage Pit: Distance to nearest well--/n_e-- -_ Distance fr ,fo�tndafion-/�--_-_-----.Disfapce to nearest lot line--,16-�------ � Number of pits------/-------------Lining materialr _-__Size: Diameter---7 ------ ------Dept h--�- Q- ---_-_----_--_- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------___----___-----_____---_ ❑ Size: Diameter-------------------------------------Depth---------------------------------------------------Liquid Capacity----------------------------gals . Privy: Distance from nearest well--------------------------------------------------Distance from nearest building----.----------------------------------... ❑ Distance to nearest lot line------------------- -- `%----------A------------------------------------------------------- r f Remodeling and/or repairing (describe):-- l ----------------------------------------------------------••_-------------------------------------------------------------------------------------------•--------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------—----------------------------------------•------------------------------------ - ---------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State�aws, and ules and r ulati s of the San Joaguin focal HealA District. r Si ned -- - .-r- =------T----------- --------- -A- ---Owner and/or Co tractor y---------- - - ---- 4� _-------. /- B ! [Tit e) s (Plot plan, shoin ,size of ot,1 Ea o of sysfem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY------------------------------------------------------------------------------------------------ DATE4��.----------------------------------------•------- REVIEWEDBY------------------------------ - --------- ---- ------------------------------------------------------------------------------ DATE _ ' - - DATE-----------�- ------------------------------------------ BUILDING PERMIT ISSUED r:; ------------------------------------- Alterations and/or recommendations---------------------------------------------.---------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------i----------------- -------------------------------------------------------------------------------------------------------------------------------------•------ r ' -------------------------------------------------------------------------------------------------------------=--------------------------------------------------------------------------------------------------------------- # ---------------------------------------------- --------------------------------- ----------------------- ------------------------------------------------------------------------------------- , '�,.. ,,'�---------- Date------- __ `,. Al- FINAL INSPECTION BY.--- ----`�� s SAN JOAQUIN L C L-HEALTH—DIS-TRICT k 130 South Amefican<Stre 300 a tvOak Sfreet 132 Sycamore Street,- 814 Nort "C" Street Stockfon r6alifornia h CalifManteca, Califor� Tracy iR ornia ES-9-2M 8.51 Revised W-2100