2521 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No,__&��---------- (Complete in Duplicate) Date Issued -Y6_ Application i s hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This applicatidn is made in compliance with County Ordinance No. 549, JOB ADDRESS AND LOCATIONS ------- -- - --------- -e----------------- " ----------------------------------- Na ------------------ Owner's o -- ------- ---•---------- --------- Phone_;?-------- --------------------------------------------------------- Phone- ---------- 2Z------ ,C Address ...... - - -- --------------------------------------------------------------------------------------------------------------------------------------- qP KI Contractor's Name----- ------- --------- ----------------- Phone------------------------------ .Anstallation will serve: Residence Apartment House E] Commercial [] Trailer Court E] Mof9I E] Other ❑ 1111 - — ' X /00/ Number of living units.- Number of bedrooms ___I___ Number of -ths ___1 Lot size __C5_0___ ---------------------------------------- Wafer SupplyPublic system E] Community system -[] Private ��Depfh to Water Table -------- ff. Character of oil to a depth of 3 feet: 'Sand�;a Gravel F] Sandy Loam E], Clay Loam.[] Clay ❑ Adobe Hardpan El . 11 i . I Previous Appli afion Made: Yes E] No [ New Construction: Yes M"No El All" c TYPE OF INAALLATION AND SPECIFICATIONS: ;,(No septic "tank.or cesspool permitted if public (sewer is available within 200 feet d ��f AF NJ Septic ank: Distance from nearest well--�O Distance from foundation_____ ---------Material-- ___-__•_____-___-_______ ------- I No. of compartments---------- -Si,e--------------------------------Liquid dept---------------------------Capacity------- - -- Field: Distance from nearer} - ------Distance from foundation ------- -Distance to nearest lo li I C,-4aT it Pispo�� Field: �aresf well-- on --------- Number of lines-------------f 11-------- Length of each line--------------- Width of'french---- ---------------------------- ai ---11_4_1W4Depfh of filter materia ______Total length________ --- Type of filter material material______—T-6 h--------- ---------------------- • - Seepage Pit: Distance to nearest weli----------------------Distance from foundation--------------------Distance to nearest lot line_______________._ a ❑ ine----------------- El Number of pits----------------------Linipg material-----------------------Size: Diameter------------------------Depth--------------------------------- ecipssp o1k- Distance from nearest well�1510---Distance from foundation------------------- Lining material----------------------------- -------- f Size: Diameter----.---------------------------------Depth----------------------------------------------------Liquid Capacity----------------•---------•-gals. Privy: Distance from nearest well-------------------------- ------ -------------Distance from nearest buildin9-- ----------------•---------------------- ❑ Distance to nearest lot line--------------------------------------------------------------------------------------------------------------------------------------------- - Remodeli-ng and/or repairing (describe):-------------------------------------------------------------------------------------------------------------------------------------------------------- ry iiii ....ap------ii............A_ ----------- ---- ---------------------------- .......1-1.1-------------------------_------------------------------------------- - - _, ---- --- -------------------- --------- --------------- I—--------- ------------------------------------------------------I-------- ----------------------------------------------------------------------------------------------------------------------------------------------------- I hereby gertify that I have prepared this application and that two work will be done in accordance with San Joaquin County ordinances, SA,ife, laws, and rules and, regulations offhe San Joaquin Local Health District. (Sighed)--------- -K-4A--- -------------------------------------------------(Owner and/or Contractor) -------------------------------------- By:------I---/ (Tale)---------------------- --------I--------------------------- ---------------------------------------------------------------------------------------------------------------------- II: I (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED ----------------------------------------------------------------------------------- DATE5%---------------------------------------------- REVIEWEDBf-------------------------------- -------- ---------------------------------------- ---------------------------- [DATE ------------------------------------- BUILDING PERMIT ISSUED----------------------------- --------------------------------- ----------------------------------- DATE----------------------------- ------ --------------------- Alterations an'ti/or recommenda+ions:-----/4,(-(-/,�-7-- ------- ----- -------------- ------------------- ------G cl -------------- ------ ----------22, 7!R ----------- S_0------Do -- --------Af--------7 ----------- ------------------------------------------------------- FINAL_ INSPECTION BY:------ ----------------------------------------- Date---------d' ------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South ma,;can Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Sfocktol California Lodi, California Manteca, California Tracy, California Ali ES-9--2M 8-51 Revised W-2100