3836 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No.3 f-. ----- (Complete __.(Complete in Duplicate) Y.: 1 / Date Issued A cation is hereby made to the San pp y 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 AND TLOCATI N_____________ �? - 1� -•- Owner's Name.-__. -------------------- � � �� ------- ------ Phone-------------------------------- F` i f 7� Address -•--------•-------------------•---------•------------------------------ Contractor's Name----------------------------- --------------------- ^4 _.L--Y----------------------------------•-----------.-- ---------- Phone Installation will serve: Residence sr Apartment House E] Commercial El Trailer Court E] Motel [:] Other 171 Number of living units: ---1--- Number of bedrooms __ ____ Number f baths -_ ___-- Lot size ------ _ _ ^ F Water Supply: Public`system ❑ Community system ❑ Private Depth to Water Table ft. Character of soil to a depth of 3 feet: SandGravel ElSandy Loam 1-71 Cl Loam ElClay ElAdobe M/Hardpan a Previous Application Made: Yes ❑ No New Construction: Yes F1 No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic'+ank or"cesspool permitted if public sewer is available within 200 feet.) Septi ank: Distance from nearest well___ Distance from foundation____.J,�_______.Materi�l_.----._ - No. of compartments--,_____ Size___. . a � Liquid depth- -(i-- ----- ._ Capacity (� Dispos Field:: Distance from nearest well (� -Distance from foundation __�-6e'_....Distance to nearest to lipe____l ' Number of lines________ __ Length of each line______�- Width of trench-__-- t / fi ------ ---- Type of filter material__ p T - --De th of filter material---- /� ----Total length--------------- --------- Seepage Pit: Distance to nearest well--------------.-------Distance from foundation___________________Distance-to nearest lot line-----__----------� ❑ t Number of pits----------------------Lining material---------_-------------Size: Diameter_--------------------Depth------.----.--------------------- �! Cesspool: Distance from ne'ar'est well------------------Distance from foundation____________________Lining material,----------------------------- ❑ Size:'Diameter------ ---------- s Depth------------------------.-------- _-Liquid Capacity g----------------------------------------- Pri;v nDisfa' nce from nearest well q p Y gals. t :_--_--._Distance from nearest building resp lot line == ----- ---------------------- ❑ Distance to nea Remodeling and/or repairing (describe) l _____________e ` t __________________________________________________________ ___ 3 __ ____�_____'______-______-_______._-__-__________-__________-______________._____--_.___---________________--.--_.____-__. __________________________________________________»_ _____._1_________________________________________ ____--__-____.____-.....____-___________-.-_____________ __ I hereby certify that-1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St a laws, rulesrz� cations the San Joaquin Local Health District. (Signed) ---- --------- - ------.(Owner and/or Contractor) By:-- -- ------ -- ----------------- --_------------ --------------- -------------------------•--------------------------------(Title)------------------- -------------------------------------- (Plot plan s wing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). 1 t FO DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.------- ' -------------------------- - DATE : WI * --- ------------ 1tEVIEWED BY-----!----___-•- + :• DATE.........--- ... - -- ---------------------- BUILDING PERMIT ISSUED- bATI=-.- Alterations and/or recommends+ions:_ ----••----------- -----------•----------_---------------- ------------------------------ ----------------------------------------- 1 -- i ---------------------------------------•------------------------------- ------ -------------------------------------------------------- -----=---------- FINAL INSPECTION BY:---------------- --- ----- ------ Date--------------- -- ---- ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street I 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockfon, California Lodi, California Manteca, California Tracy. California ES-9-21M I0-52 Revised W-2100