10223 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. ..ld-- ..� (Complete in Duplicate) Date Issubd p q� Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This a .plication'i�s�mede-inrcom.plian�with County Ordinance No. 549. JOB ADDRESS AND LOCATION---- ------ ------ ------------------- ------ Owner's Name ----- SZvtin S --------------------------------------- 1�a' Phone--- `S -- - 1 Address----------- -------- ;?,---------------------------;?,LX13--------------------- __ - N----�9�c�---------------•----------------------- -------••- Contractor's Name---------------------------------------- ---------- Phone----------------------------------- Installation will serve: Residence Apartment House.❑- Commercial ❑ Trailer Court-0 Motel I] Other ❑ Number of living units: --2--Number of bedrooms -------- Number of baths J_-_-- Lot size ----- --•---------------------------- Water Supply: Public system Commuriity system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loa Im ❑ Clay Loam ❑ Clay ❑ Adobe M—liardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes EKNo ❑ FHA/VA: Yes ❑ No [E-' ` TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if pub' sewer is available within 200 feet.1 Septic Tank: Distance from nearest well __ _ .---Distance from foundation--- Material--_-.-L lam- 1Q---------------- [►/ No. of compartments---------?-------- --Size----�. K } Liquid depth L/ Capacity _ Disposal Field: Distance from nearesf'well'__ . - Distance from foundation__ �-.____--.--.Distance to nearest lot lined _____-- ❑ Number of lines-_------2----_---------------Length of each line------ Q-----��-`---------Width of french.--- �/��--------------------- ;� Type of filtei material---Mt' ------------Depth of filter materia ____-___-.Total length------._-1-&Q-------------__-----_-- Seepage Pit: Distance to nearest well----------------------Distance from foundation---____.._____----.Distance to nearest lot line----------------- - ]_ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------- ----------------------- Cesspool: --- ------Cesspool: Distance from nearest well---------- ------Distance from foundation--------------_-----Lining material--------------------------___._------- I ❑ Size: Diameter Depth----------------------------------------------------Liquid Capacity----------------------------gals.�-- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--_-.-__--____.------_-- _----------.-. f' IDistance to nearest lot line--- ------------------ -------------------------------------------------------------------------------------------------- _'hS� Remodeling-and' ----------------- ---------------------------------------------------- , /or repairing describe ---------------- -- ---------------------- i ---- ------------------------------------------------------------- -------------------------------------------- ------------- - --------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regui -of the San-Joaquin local Health District. [Signed __ --- ------------------------ --------------------- ------------ -- -----------=---- -------- ._.(Owner and/or Contractor) - Title] -------•-------------------------- .�---:� ----------- --- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc.,' can be placed on reverse side). FOR [APARTMENT USE ONLY ! � Na`� J —APPLICATION ACCEPTED; BY F, ��------- ---- ------------- ----------------------- - ------------------------------- REVIEWED ------------------------------ REVIEWEDBY--------------------------------- - ----------•-------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------------------------------------------------------ --------------------------------------------- DATE----- ---------------------------------- ------------------- Alterations and/or recommendaf ns:-------- -"_ --- -- ----------------------------- � W'D 0 ZZ "' �`"'�` ---------------------------1 ---r�. ``'� •rte .--rte----- ;'� ---------------- ----- ----------- ---------- �° ----- ` Gt-.- -' -- - - - - .rte---- ------ �.. _ ------ - - -tom-- Date-- J ( - -------------------------------------- SAN JOAQUIN TION BY------- -- ----------- --------- ---- ---`-'-- - --i--" ------- SAN JOAQUIN LOCAL HEALTH DISTRICT ' 1 0 So A erican Street 0 West Oak Street 132 Sycamore Street 814 North "C" Street �R!Iiw.6 Lodi, California Manteca, California Traey, California ES9 F.P.CO.