5214 - Laserfiche WebLink

Home Browse Search

�Jy ll{ APKICATION FOR SANITATION PERMIT Permit No. `5-�:_ __- y (Complete in Duplicate) �� Date Issued -- •-- 7 ---- 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 AN LOCATION--.__.. Owner's Nam ---- �. _ ._ + ------------- ------ ------------------------- one l Ph :a. _ N Address. -••---------------•W-.. QrfR :-- � R G tX.------------ _--------- J S Contractors Name. f a•f �.�'F _�:/7C.� -------------- Installation will server (Residence Apartment House ❑�C�mercial ❑ Trailer Court. E] Motel ❑ Other E]Number of living units: ..--"Number of bedrooms Number of baths __f--. Lot size -./_4•a4 ------------- -- Water Supply: Publicisystem [] Community system ❑ Private Depth to`Water Table Character of soil to a depth of 3 feet , Sand 0 Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Mi Yes ❑ No [ ' New Construction: Yes ❑ No ❑ f ,. TYPE OF INSTALLATION AND SPECIFICATIONS: F (No septic +ank`or cesspool permitted if publicsis available within 200 feet.) ` _� Y Distance from nearest wll:.___-._,_______ . ....._. tic Ta e 'Distance from foundation----=-- ------------Mater11 ial. ..No..of.compartments----------------- Size---------------- is os I Field: Distance Liquid dept '--------Capacity------------------------ Isp Mance from nearest well.,__ _...:..Distance from foundation__.-.-_._. .:.....Distance to nearest lot line--------- --------- Q I Number of line's------ - _--- tf-tl-- Length of each line-.eQ------ �- -----Width of trench-_ -----------------•--- ( .1 *� Type or filter rraterial...!< _ _� 15-._Depth of filter material-._Z. -- .-_-__-Total length------jz?_o_-------- - Seepage Pit: Distance to nearest well t2_'` _:Distance fro foundation ..-- ie -51-- N #o nearest I t line_--._�...._-- �Nurri6er of pits...._-i.'_---- _---Lining material-- (__size.' .-..Size:'Diameter._,3J" Dept h_-�_- Cesspool: . Distance from nearest we1----'_._i"..':Distance from foundation---- Lining material...---------------------------------- -------- ..............__-....__.._-_-.._ ❑ Size: Diameter ; = --------Depth- ----- ----=--�___:----------`-- ........... ---- -- Liquid Capacity gals. Privy: Distance DDiissttaannccee'#faro"nmeanreeastrelsott wlienlel.-:_.-_-,-- -"---' ------ 'Dista nce from nearest building-4------------------ eand/or-repairing .............. -:- ----- - ,^ ----------------- mo`ldeling (descri�kI A : i I -T =- ----g---------- -------- ------L---- - -•----••---------------- - ---------- --------------- -----=-- ----------------------------------------------------------------- -------------------------------------------------•--------------------------------•-------•----------------------------------•--------------•------------- -- hereb hereby-'certify + I have Y y prepared this-application and that the work will be done in accordance with San Joaquin County ordinances, State land rules d`regulations of the San Joaquin Local Health District.' i � I. (Signed)------------•----- -------------- --- – • -I Co --------------- (Plot plan, showing size of lot, location cf system in rel tion to wells, (dings, etc., can be placed on reverse side). ~ � FOR DEPARTMENT USE ONLY " APPLICATION ACCEPTED BY s�/'____ . ------------------- DATE------<�' I. .. , REVIEWED 13Y - ---_--------------------- --- , r DATE BUILDING PERMIT ISSUED_----------- = - -----•--------- -------------------------------------- ---------•- - .. DATEAI}eratians and/or recommendatons: . = ----------------------- ------------------ ---------------------------------------- -------------•------- ----------------------- --------._------------------ ---.-._-......_------ _ : . _ / ---------- FINAL INSPECTION ------=-- = "- Date-..---_-.- ` 1 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Soufh.,American Street. 300 West Ciak Street- 132 Sycamore Street 814 North "C" Street ,. Sfockton, California Lodi, California" Manfeca, California Tracy, California ES-9-2M ; Revised W-2100 ,r L