5203 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. ..-.-------•- (Complete in Duplicate) Date cescribed Application is hereby made to'the San Joaquin'Locel Health District for a permit to construct and install the work heirs This application is•mede in compliance with County Ordinance No. 549. r �M Portions of Lot II & 12 Dais tract S. side.S��inger-- ari®--- "--------------- JOB ADDRESS AND LOCATION---------------------------------------------------------- •- -----------------------•----- -- I _ Phone.9.3119--.Lod- � - ------------------ Owners Name__________ � ®s iBax 264`Lodi ---------- ------------------------ p� .�3o Address--------------------------------------= Eone ------ - ------•-- Contractor's Name-----------------Mme-.------ ------'------------------------------•----------------------- - P - 1 Installation will serve: Residence.[ Apartment House ❑ Commercial ❑. Trailer Court [I Motel. C1 :Other;❑� ; x ------ i Io oao s fte------------- - Number of living units:!-------- Number of be _-_2___ Number of baths __._____ Lot size ________:_____________Q�__--- } Water Supply: Public system F-1Community system Private ® Depth to Water Table ---W_ ft.❑ p Adobe E] p an Hard Character of soil.to a depth of 3 feet: Sand E] Gravel [:] Sandy Loam [y Clay Loam [I Clay ❑ E] { } Previous Application Made: Yes ❑ No'E3 New Construction: Yes ® No ❑ 1 TYPE•OF INSTALLATION AND SPECIFICATIONS: No septic tank or cesspool permitted if.public sewer is available within 200 feet.) - - --.Material _�_�__�`--------------------------- Septic ------------- ----Septic Tank. Distance from nearest well:_=y- _Distant from fou.,,a on------ ---------- 'r �1 "�' y-- x-'`^7-•-------_Li Liquid de ----- CapautY No.-of.coimpartments------------------------ Size__ l� --- q 5 Disposal Field: Distance from nearest well__ Distance from foundation--------- to nearest lot line-------_-------- Disposal of lines-----:L___------ I--- ---Length of each line-----_49--- r4--------"Width of trench----3__f-._--- ------------- Type of fillter material------ -- [-2Y -� Pth of filter material-------z�-----------Total length------------------------------------------ 1 Pit: Distance Ito nearest well_._--._--------------Distance from:foundation ------------------Distance to nearest lot line__._______._- Number of pits-------- -------------Lining material------- ------------ Size:Diameter------------------------Depth--------------------------------- Cesspool: Distance from nearest welL----------------Distance from foundation_._._____-______--.Lining material______._.__._ ___.______.__.-..______ meter Depth-------------------•• ------------ Liquid Capacity_;---:--Tr _:gals W_ Privy: Size: D1elFtrom nearest well---..---------------------- ------------------ Distance from nearest building------------------------------ Distance ------------------- F ❑ Distance"oto nearest lot I I - l ine- - -------------------------------------------------------------�-------- -- ----------••-- a Remodeling and/or repairing (describe):_____. ---------------------------------------------- ---- ----------------------------------- ---------------------------------•----------------------- -------------- ------------------------------------------- - _ ------------------ - M -= ---------------------------- ----------------------- --••------•-` -------------------------------------------------------------------•-----•--------------------•-------------------------------------•------------------------------- I hereby certify that I }ave prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, ancIF'ules and regulations of the Sap Joaquin Local-Health District. --------------- ----------(Owner and/or -Contractor) a t (Signed)--------------------- ----- SAS • I .� �,,�----`. (Title) (Plot plan, showing size of I t,•location of system in relation to wells. buildings; etc.l can be placed:on reverse side).. - i FOR'DEPARTMENT USE ONLY fDATE.----- ---- ------- ------- REVIEWED SY."" ` 1 BY--------------j -------------------------- APPLICATION ACCEPTED -,,,—�T ,. BUILDING PERMIT ISSUED ------ ------ --------------- ------------•-----•------------------------------- DATE-:7 -^L- = = = == c Alterations and/or recommendations: -----•------------------------------- - ---•------------ ----------- ------------ ------------------------------------------- - --------------------------------------------------------••-------•------------------------------------------------- I ---------•--i:--------- `, L _______________________________________________ A ----------------------------------- - i - �,-• �--Y �C - Date ---___....__ ---- -------- --___/ 151 ;: _ _.___. ______ __.__. - ---- •----- .________.___.____.___.___._______._ --- ------ -------------------- --------- .FINAL --------.FINAL INSPECTION BY - - �I SAN JOAQUIN LOCAL HEALTH DISTRICT k ie ' 300 West Oak Street - 'F132 Sycamore Street 814 North."C" Street 130 South American Street Trac California Stockton, California I� Lodi, California Manteca, California YI � I ES-9-2M 10-52 Revised W-2100 ' Y.