CO0013778 - Laserfiche WebLink

Home Browse Search

a APPLICATION FOR SANITATION PERMIT Permit NO. . ..... hl (Complete in Duplicate) C' - Ddte Issued Application is hereby made to the San Joaquin Local Healil, District for a permit to construr t and install the work herein described. This application is made in compliance with Ccunty Ordinance No. 544, r, ,r ' JOB ADDRESS AND�LOCATION........ j [... GNner's Name...... ...........+.J r..--...-.-, p.. �� ............. ... Phone.................................... Address..:.............. -- _ /... antractor's Name.. ................... CPhone..- .: ✓....-.. Instalation will serve: Residence [ APartmouse ommarciol ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ...... Number of Zrc,4-....... umber of baths ...1.-. Lot size .. S�..X.... er ,r..... F Water Supply: Public system, i] Community systorn rivato X Depth to Water Table i�97ft. Character of soil to a depth'of 3 feet: Sand❑ Gravel n Sandy Loam❑ Clay Loam❑ Clay❑ Adobe [ Hardpan ❑ Previous Application Made: Yes © No Now Construction: Yes E] No TYPF,OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se t❑ic Tank: Distance from noaresr wall.................Distance from foundation....................Material................................................ P No. of compartments..........................size................................Liquid depth------•;..-...............Capacity....................... Disposal Field: Distance from nearest well Distance� Distance from foundatio.n...JW.r-r.........Disiar%ce to nea..r.o.s.t l�ot. lin•er.. ..f...Q.. ............ ..........Wdth of trench.. % �Number or lines....� .......L9ngth of each line. ... Type of flt !%�r.Depth of filter material.. Toalogth....or material -..... ....... Seepage Pit: Distance to nearest well......................Distance from foundction...........--......Distanco to nearest lot line.........----.... El Number of Pits......................Lining material......................Size: Mameier.......................Depth................................. - Cesspool: Distance from neareet well.................Distance from founda'ian... ................Lining motorial.................................... ❑ Sizv: Diameter.....................................Depth......................................--..........Liqui8 Corocity............................gals. 1 Privy: Distance from nearest well.................................................Distance from noorosi building........................---.. ❑ �.; ' Distance to nearest tat lin©---•......--��----•..............................................................................................•----........-�-�----------- ' Remodelin and/or repairing doscribe:....-. �.-.. ;.t. ! �........-- �.-.,. 9 � P 9 ( ) ...-.-.- rte- 1 II...................� .... -. .t.--• --- ....................................-........................................ q .............................................................................................................................................................................................................................. 1 horebycertify that I have-pl6ji re this application and that the work will be done in accordance with San Joaquin County S ordinances, State laws,eft rel en gulations of 'rho San Joaquin Local Health District. (Signed)............ / ...�' si.. "�-�r...f-'.-Y...... .......:... {Owner awd/� Cot cfor) $y:......................................... > 1.....-...IC je!........ ._df is rt r4 (,...(Title)......../ a- -G :..:...........-...... (Piof plan, snowing size of lot, location of systom. in relation to wells, uildings, etc., can be place' on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY............... .......:,.......'i .:.,. ...---........-- ATE-...--•-� --�-- , REVIEWEDDY........... ................................ �S,,x r*+:.y. DATE.... ... ... .. r-�......-�.................. BUILDING PERMIT ISSUED.........f:........ ..I.'..,rr... ...:......r. DATE........................................................... Alterationsand/or recommendations:............................................................................................................................................ ................... .................................. ..........................................................................................................................................................- FINAL INSPECTION BY:........y/..: ,41. ��G!................... Date................/... ... ..`.. ...•• SAN JOAQUIN LOCAL HEALTH DISTf:1CT . 130 South Amarican S',40 300 Wast Oak Street 132 Syeamoro Street 014 North "C" Sireat Stockion, Califgrnla Lodi, California, Manteca, California Tracy, California ES-9--2M iu..,2 ReviLad W12100