8823 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. .._ --"---y! (Complete in Duplicate) Date issued r n is hereby made to the San Joaquin Local Health District for a permit to construct and install thewo3rk herein described. Application Y 4( y This application is-made.in�compliance with County Ordinance No. 549. � " 0.S _ ,_04 c.e �A- �' ---------------------- ---- JOB ADDRESS AN LOCATION. s Phone-- -------- d Owner`s Name-- _ _ z ----------------------------- --•• .--- -------------•---- 0 1, ---- -- -- R..E � --------.Phone--------••-----------------------.. Contractor's Name_ _ _ l Trailer.-Court ❑ Motel ❑ Other ❑ Installation will serve: ' Residence ,�T Apartment House [I Commercial ❑ our _ -{ ------ t ____ Number of baths _A__.__ Lot size _ _a._.r -2-- -----• Number of living units: Number of-bedrooms __ c Depth to Water Table Water Supply: Public system ❑° •Commun`ity system ❑ Private Q0 p Hardpan ❑ Character of soil to a depth of 3 feet: Sand M Gravel ❑ Sandy Loam X Clay Loam El Clay ❑ No be ❑ Previous Application Made: Yes F1 No New Construction: Yes No E] FHA/VA: Yes ❑ El TYPE OF INSTALLATION AND SPECIFICATIONS: wA (No septic tank or`cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest we114J___:_____.'Distance from foundation __ ___'-----.M��at//e Jial_________ _ __ -------------------- ------- .• = Size-1 tt s Liquid depth-----=I_--"------------- CapatitY-ff No. of compartments-----�------- # 0 p . r r Disposal Field: Distance from nearest well-+�__.A"-___'Distance from foundation�_________________Distance•to nearest o me._--------------------------`Z)� Len th of each Vine"-_ _____________I------Width of trenc�_� 5f Number of lines___._f___.___ _ g Type of filter material4.�--:--Depth of filter material-At Total length____ __.-_-------- well_____ ______ ________Distance from foundation___-_____-__--__.__.Distance to nearest lot line----------------- Seepage Pit: Distance to nearest Number of pits------ Lining material-------------------- Diameter Depth - Cesspool: Distance from nearest-well-----------------Distance from foundation-----------.._.____.Lining material_________--_______----------- ----- ____--_Li uid Ca acit gals.. ❑ - Size: Diameter-- --�---------------------------------Depth- ----=-------------•------:- ---;�-�------ q p. Y-------------------- ---- ) Distance from nearest building_________________--___-_____- _____--_- Distance from nearest well____-_.---"-- ----------- __ Privy: _ - ------------- -------------------------------•------- ❑ Distance to nearest lot line-----------------------�-.----- ----------- { Remodeling and/or repairing (describe)------------- -------------------i---------------- - ------------------------------------- ----- ---------------------- ---------------------- �. •------------------ ------ -----------•-------------- --- ------ ----- •--- ----- • ---- ---------•--------------------•--------- ---- •---------------- --------------------•--------------------•----------"I ___-____ _E_ . I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinance State laws, and rules and regulation7o the San Joaquin Local Health District. O wner an 'Contractor) and/or n ra or (Signed)---- _ h �. ------------------------------------- ,t, - -----------------•----•--•-(Title)----•---- --"--------------------------- — - - - (Plot pl ,:showing site of lot; location sof-system . relation to wells, buildings,'etc:, can be placed on"reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- - - -------------------- DATE REVIEWED BY---------------------- ------------- ---------------- -------------------- -------- --- --- ---- DAT DATE---------------------------------------- BUILDING PERMIT ISSUED---- =---------------------------------------=------------------------ Alterations and/or recommendations------------------------------------ ----------------- -------- ------------------ ------------------------- - _ = ___-`5- ----------- ----- F1NAL INSPECTION BY-.-" -.-.-°�'-'�----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 132 S camore Street 614 North "C" Street 130 South American Street 300 West Oak Street y Tracy, California ' Stockton, California Lodi, California Manteca, California j5-9-2M , Revises 1-57 FYCO.