5477 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. �, 77-__ ell (Complete in Duplicate) q //7 j Date issued!--�1-./,- 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. i JOB ADDRESS AND LOCATION.---�Q �.I-O P l - --------- f,------------------------------------------ Owner's Name-----------------------=---------------Ve-Vr10 x---- --iQb-b---- F ------------------------------------- �4. Address--"�--------=---------- � �� a= �IO�E/? �Cl�� ------------------•----•-----------•----------.--------•--------------------------•- I / Contractor's Name-----`_______________•----•__ _._ �`I'LSC1_._ /?-Cr---.-----------=- ------ Phon _-lam � t Installation will serve: Residence If—Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __Y Number of bedrooms _:Number of baths __ LOt size ---ZAP ---------------- Supply: Public"system �" Community system ❑ Private ❑ _.Depth to Water Table ________ ft. Character;of soil to a depth of 3 feet:. Sand ❑ Gravel ❑ Sandy Loam E] Clay Loam E] Clay Ef Adobe,C Hardpan E]Previous Application Made. Yes ElNo�New Construction: Yes❑ No ❑+� . I TYPE OF'`INSTALLATION AND SPECIFICATIONS:�. . #. � 1 (N'o septic tank or cesspool permitted if public sewer is available within 200 feet.) {c T k; Distance from nearest 'well,________________Distance from foundation i__________________-.Material _______ __---------------------------._______. p - ------------Size------r ---- -------- -------Liquid depth------------------------ Capacity------------- --------- No. of core artments_ L� osal '' d: Distance from nearest well-14;w@.._Distance from,foundation__/Q---------Distance to nearest lot line___-%T--- 1 Number of lines. -' -�Length of each.line v'�- - -------Width of trench.---a� -------------- W ,' Type of filter material_ ` ___Depth of filter mater3aL._.��".-____-_Total length_}_fid_'_________________________ W r _ �- .k Seepage'Pit: Distance to`nearest:well__________ _____ ____Distance from. foundation___________________ Distance to nearest.lot line-_____:__________ ❑ Number of pits.-----#----- ------ g �`` p • �--Linin material--------------- - Size: Diameter- -- -------------.De tn--------------------------------- 0 s Cesspool:! Distance from nearest well----------------_Distance-from foundation._........----------Lining material---------------------_--_-___________El . Size: Diameter--------}-------------- -------------De th----------------- ------ ----Li uid Capacify -----------gals Privy:: Distance from nearest well-------------------------------------------------Distance from nearest building_A------_---__----_______________.___.._- Distance to nearest lotdl ne-- ---------------- ---------------------------------------=------------------------• 1 I t ' f Remodeling and/or repairing (describe):_________________________________________ 4 ________________________________________________a:__._______________-__--_--________-_______________._____--- .{i. ; ________________{i___________________._______i______________.__________.____.___________________.__--_-_____..-_.__._________4_________________________._.____________________________________________-_._.--_________-___-__. t ' ordinance-------------------------------------------------------------•--•-•----•-----------••-----------------•------=----•----•----------• --------•-- ------------------••-------------•--------------------------- I hereby cerci y at I have p lepared this application and that the-work will.be done in accordance with San Joaquin County ' State aws and rules nd re ns of th San Joaqu'sn Lo al Health District. K , {signed} Erl'ls- ------ --- --- o Contractor) BY`r ---=--------------------------------------------- (Title} A�" (Plot plan; showing size of lot, location of system in tion to wells, bu logs, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------- ----------------------`---- ------------------- DATE---------------- REVIEWEDBY------------------------------------ ------------------ ---------------------------------- DATE-----------•-----------•-------•--... - BUILDING PERMIT ISSUED------------------------------------------------------------------------ -------------------------------- DATE Alteration"s and/or recommendations:---------------------------------------------------------------------------E-------------------------•--------------------•-----•---------------------------- --------- -'' ---------------•---- ------------- - ----------------------------------------------------------------------------------------------------------------------------------•--------------- ----------------'------------------ti------------------------------------------- - ------- - ------------••--------------- --------------------------------------------- ----------------------------------------------- # FINAL INSPECTION •BY---------=----=----j---- -e --------- Date-----------------------------. . -- ----------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stock+on, California Lodi, California Manteca, California Tracy, California ES-9--2M Revised W-2100