7601 - Laserfiche WebLink

Home Browse Search

IZ APPLICATION FOR SANITATION PERMIT Permit No. ..... (Complete in Duplicate) Date Issued Applica{ion is hereby made 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 Ordinance No. 549. JOB ADDRESS AND LOCATION_ __011-9..--------• r ---y-6�- ------ Phone--------•--------•-------------- Owners Name--••------ -I--MA!,E ------------------------•-------------------------------- ------------- -----------------�- Address. I =j Phon _..----------------------------- 77 1--------------------------�_ --• ,[ Contractor's Name �� ' Installla+ion will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: !-_i____ Number of bedrooms-3. Number of baths -/--- Lot' size ___--- -'------��--1 0 Water Supply: Public system�J[�Community system [I Private ❑ Depth to Water Table 0ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel F1 Sandy Loam El Clay Loam E] Clay El Adobe Hardpan ❑� a Previous Application Made: Yes ❑ No [R�New Construction: Yes 5�-'No El : i TYPE OF INSTALLATION AND SPECIFICATIONS: . { (No septic tank or cesspool permitted if public sewer is available within 2( feet. Septic Tank: Distance from nearest wehl-1-�-Distance I rom fos+ndation__._1�-__._____-Material-___________________________ -- ° X_Li-Liquid de 4h..��--- ------Capacity_�F No. of compartments.-.-�-.--`---------Sixes__ - Q P. Disposal .ield: Distance from nearest well..1&AA/._Distance from foundation_____ ___ ______.Distance to nearest lot line________-s0. �!r ! t Width of trench..o�- ------------------- ---- Number of lines--./ -- ---- --- --- - Length o Y ac i ----��-- ---r:-----�- i De filter mat r I---4 :-- Total length--------7-f------------------------ Type of filter materialo�!(sc�- - : 1l i Seepage P Distance to nearest well io Q,j . ____._ ista c om oun ati ---.�� -.__Dista a to nearest lot line___e.----.____- r Number of pits_--/----------------Lining mpteri I-_ _-- ----..Siz Diameter------- .-A__Depth------. -- ----------_----- • Cesspool: Distance I�f rom nearest well------ -- _D.istance from fou ation-____. -------- Lining material_____________________________________ Liquid Capacity _____gals. ❑ 11!efier_. ----------------------Depth------------- --- :-- 9 9 ' Size: Dia Privy Distance:.,rom nearest well---:----:--------- ------------------ Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line------------------------ --. --------------------------------- Remodeling and/or repairing (describe}:-------------------------- - - ----------------------------------------------------- -------------------------------- ------------•-- ------- ------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances. Stafe•laws, and rules and regulations of the San Joaquin Local Health District. 5i ned ' DAY NIGHT _--___ ev-Contras+or] ( 9 ] Sep#ic Tank "se7k2 e - ----- ------ - --- ----------------- 1206 SIt Eiclorado -7046 Title___ .___.__ sy:._ . ( ] (Plot plan, :.9size size of lostg�a $Piro °Isfem'in re at to wells, building , etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY ----------------------------- APPLICATION ACCEPTED `BY------------------- R ------------- ---•-------------------------------- DATE------ REVIEWED BY--------------------------------- - ----- --- ---- REVIEWED •----- DATE----------------- BUILDING PERMIT ISSUEDif-------- ---------- - ------------ ------------------ DATEti ------------ - Alterations and/or recommendations--------------------------- fo----------•------------- 11: .. ---- •--•-•-----------•--•------•---------- ---- 1[------------------------------------------------- --------- ---------------- ----••------•-------------•----•---------------------------------------• -------- --------------- ---------- ----------------------•-----------•-------------------•---------------•----------- ---�.----------•-------•--------------------------•----------------•----------------------- FINAL INSPECTION i3Y._ _ -- -r'�'_--�----- - - ------ ----- ----- Date---- ---- -------k ::n--------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Stree+ 130 South American Street. 300 West Oak Street Y Stock+on, California i Lodi, California Manteca, California Tracy, California E5-9-ZM 145446 ATWOOO 12-54