5801 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit. No. (Complete in Duplicate) Date Issu/d --/---------- gA cc p ca+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. 's application is made in compliance with County//Ordinance- o, S49. JOB ADDRESS AND OCATION---------- -------1..1 ---------------------------------------------------------- ........... Owner's Name------- --------------- ------ --------------- --------- Phone/ -------- --------------------- ------------------- Address...................... 5h-e V_---VZ7 --------------------------------------- -: A — ZW e , Contractor's Name--------------------------- - ------------------------------------------------------------------------------------- Phc?ne./7/,$---&-�A47- Installation will serve: Residence n Apartment House 0 Commercial E] Trailer Court 0 Motel 0 Other ❑ N M'ber of living units: -1------ Number of bedrooms ._y Number of baths I--____ Lot size ---- . 7 ..................... u Water Supply: Publicsystem % Community system E] Private El 'Depth to Wafer Table -ft. Character of soil to a depth of 3 feet: Sand [] Gravel D Sandy Loam E] Clay Loam [j Clay 0 Adobe Hardpan ❑ Previous Application Made": Yes E] N oZA New Construction: Yes [_], No.K TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank- (W& Distance from nearest well-------------------Distance from foundation---------------.---.Material------------------------------------------------- Ej a No. of comparfments---------6-------------.__Size--------------------------------Liquid depth---------------- ---------Capacity----•------------------ Disposal --------Capacity----------------------- Disposal Field- Distance from nearest well-..._--_-_-____---Distance from foundation----------_4--------Distance to nearest lot line______`.________ E] 07M50 Number of lines-----------------------------------Length of each line------------------------------Width of trench----------------------------_---.._ Type rench-------------------------------- Type of filter material-------------------------Depth of filter rnaferial-------------------.:--Total length------------------_------------- --- Seepage Pit: Distance to nearest well_tV,4A14F___-Disf6nce from foundation--*.6--'----.--.Disfance to nearest lot line- 1 140--------- Number of pifs_P_W_4E'._.----Lining mate Size: Diamefer_�-T------------Depth__,Z�_ ------------------- Cesspool: Distance from nearest well----------------Dist'ance from f6unclation------- -- ------ -----Lining material__-_____--___...__._.______.__-___-__ Size: Diameter_____..___-- ------------------Depth---------------------------------------------------Liquid Capacity----------------------------gals. Privy:, Distance from nearest well----------- --------------------------------------Distance from nearest building_.-._____-_____________-_---------------- 17� Distance to nearest lot -------------------------------------------------------- Remodeling and/or repairing (describe]: -------- ----------------- J.. xr --------- "-;-; �Z------------------ yl - ---------- ------------------------------------------------------ ..... ------- - -------------------------------------------------------------------------------------------/ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify fhaf_44ia repared this application and that the work will be done in accordance with San Joaquin County ordinances, State lam and rule nd regulations of the San Joaquin Local Health District. (Signed]-_ -------------------- -A&IS'll---------77Zr,_�,-------- ---------- ----------------------------------------------Aqwner and/or Contractor) By:.................... --- -------4T-------- - - ----------- - -----------------------)Title)--------------'-- w ------------------------------ (Plot plan, showing size of lot, location of system in relation to ells, buildings, etc., can be placed o0everse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_' --y ------------------------------------------------------------------------ DATE _ t—ri--------------- REVIEWED BY---------------------------- ---- -- DATE__ ------------------------------------------------------------------------------------ -- BUILDING PERMIT ISSUED------------------------------------------------------i------•-----v------------------- ----------- DATE---------rc-------------_--------- Alter ions and/oqiecommendations':----------------------- :----------!---- --------- ----------------------- ---------/7----------_---------------- (,0 ------------------------------------------------------------------------------------------------------------ -------------------------------- #----------I--------- -------------------------- --------------- ----------- .............. ------ ------------------------------------------- !------------------------ ------- ---------------------------------------------- _0'j- - ?I ----------- ....... --------------- -------------------------- ----------------------------------------------------------------------------------------------- ------- ------------1;W.11------------------------------------------------------I--------------------- FINAL- INSPECTION LBY:-------------------------------------- ---------- -------------- Date------- ------------------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street S+oc1c+Q", California Lodi, California Manteca, California Tracy, California ES-9-2M Revised W-2100