9063 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. .._ � T (Complefe in Duplicate) - _ _ _ _Date Issued �✓ f _ '� _ 70_-r�_wf__. Applicafion is hereby ' ade 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 Ordinanc No. 549. ° I JOB ADDRESS AND LOCATION__.___-�._ D Owner's Name_ s , --, r ..---- --------------- _. .R ---------------------------------- Address-.--,.------------------ - P - ho - -- ---= ----- --- Contractor's Name--------------- ------------------------- I - -- ------ 4 ---- " ;_ __�` ..............RPh ne� --------- Installation will serve: Residence vte Aparfinent,House Commercial [] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1_-_ Number of bedroom' s ---,Number of baths _1--- Lot size _________ __ ___ Water Supply: ,Public,system ❑'`Commuriit system / �� i Y Y Priv ate'❑ Depth to Water Table ___-_:° ff.- Character of soil to a#depth of 3 feet: Sand ❑ Gravel ' y , ❑- Sandy Loam ❑ Gay Loam E] Clay [I Adobe ardpan ❑ Previous Application Made: Yes ❑. No Q�ew Construction: Yeso TYPE OF INSTALLATION AND SPECIFICATIONS:~ �❑ FHA/VA:.Yes EJ , No [} (No septic tank,cr`cesspool permitted.if public sewer is available within~200 feet. / a s f .. H Septic Tank: Distance from nearest well��'�. '.` � ' � -� •�- ___._-Distance from foundation__. _____'.__--.Materia a I- _ No:.of compartments-- �`�------------- Size__'.� S l ! - ------------- ; I �- Liquid depth__---_y-- Disposal eld: Diatance-from riea rest welf_�1.v'1 .-- Distance from foundatio 's ;Capauty_.___ __ f, N of lines_____-- --__ Distance to r earesfi lot li e �_�-_[_d_ ---------- ---- ---------Length of each line_____ Q_-- 21--_ n r g Typo of filter material___._ tlr� �; Width of tre�ch-___2y -. Depth of filter material__.- � -----------_Total l -------_ --- Pit: 'Dist nce to'neare t`well "" ="'"b } - _ ___Distance from foundation___+'_'`__•:*-'-;Distance to nearest lot fine_____.~____._-___. ❑ Number of pits-_!_-________________Lining material___-_ _ _ --------Size: Diameter----------`------ -----Depth------------------------------- Cess❑ool: SiZeance from nearest well----------------Dist Distance from foundstion_ ______ Lining material-_._-.._--------------•- Diameter :Depth----- ----- ---- - ---`---._Liquid Capacity-... gals. ~ivy: Distance from nearest well__.________------------ --------- -- Distance from nearest buildin f Wl ❑ Distance to-nearest iot line_ ____- ----------------------- _- _.N m. Remodeling and/or repairing (describe:_____________ ----- ----------------•------ ._ .; -- ---------- - --------------- ---------------------- F . ' ------ - ---____-- -.----------- ----------------------------------------------------------------- --- - _ hereby certify that,) have prepared fhis application and that the work will•be done.in accordance with San Joaquin County ordinances, State laws, and ules and're ulafions of the San Joaquin Local Health District. Si nedr � e ( t 9 ) 1 -------' ---------------------Owner and/or Contractor) By:------------ •---- F ------------------------------ ------------------------------------------------------------------------- _ (Title) (Plot plan, showing size of lot, location of system in relafion to wells'buildings, etc., can be placed on reverse side). FORD~ RTMENUSTE ONLY a APPLICATION ACCEPTED BY--------- REVIEWED BY- ------ DATE-- BUILDING PERMIT ISSUED Ii DATE----------------------- --------•-------------------- ----------------------------------- DATE-----------=--------- - - -----------------= Aterations and/or recommendations:_:__---_._.__.:- - ,. ------ .----- - --------------------------------------------------------- --- --------------------•------------------ --------------------- Y ------------------------------------------ -- ---- FINAL INSPECTION-BY:------ - . ._._� •------------------ - '- Date_. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Sfreet 300 Wesf Oak Sfreef 132 Sycamore Sfree! „ Sfockton, California 814 Norfh C" Sfreef Lodi, California Manteca, California Tracy, California ' ES---9-2M , Revised 1-57 F.P,CO.