13586 - Laserfiche WebLink

Home Browse Search

5�- APPLICATION FOR SANITATION PERMIT Permit No. 15-= --/ (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 herei seri d. This application is made in compliance with County Ordinance No_ 549. Cc'7— ZOO -� �4. Z�f ta ss tAJ• �24Fr A-�-t � --.-G�-r---o-------------- JOB ---------JOB ADDRESS A LOCATIO ----------------------------------------- --- ------------�"�- - ` - - _ ------------------------------------ - ____ ___________ _ __ ___ _ - ' Owner's 3 ----------------------- ----------------------------------------------------- Address - --------------------- Address_____._ ] Contractor's Name ._ . - G > ------ --•--. oe----•-------• --------•-------- Installation will serve: Residence ❑ Apartment House ElCommercial Trailer Court E] Motel El Other`'❑ Dumber of living units: _---__-- Number of bedrooms _ ---_ Number of baths ._�- --- Lot size --- ---_--`--c- � ------- • I Private.{ Depth to Water Table F-A. ft. Water Supply: Public system ❑ Community system ❑ UB y Adobe Hard an '(Character of soil to a depth of 3 feet: Sand E] Gravel f-1 Sandy Loam Cla loam ❑ Clay ❑ ❑ P LL Previous Application Made: Yes ❑ No New Construction: Yes No ❑ TYPE' OF INSTALLATION AND SPECIFICATIONS: T. (No septic tank or cesspool permitted if public sewer is available within 200 feet.)+ w --Septic Tarik:` � Disfiance•from nearest well___�_f"41Y--Distance from foundation__:_�_6__.__-___.Materi�l___..___-_._._____________________-'`---`= �! No. of compartments.--__- -- Z----------Size_ F f-x6�jLiquid d ;th-------- ---- -- ----CaPacitY----�t �- Disp- al Field: Distance from neartest well... --Distance from foundation_.__ -----------Distance to nearest lot line_------...- ----_---Len th of each line----.---. --------- Width of trench--------2-�----------- ti Number of lines------:-----�- ----- g " .S'� Type of filter material-_ ------Depth of filter matenaL---_/1-----------Total length--------- ------------------•----� i / / is � " . _ pis�n�e to nearest lot line-- Seepage P,if: Distance to nearest'w ll_ _.___�_ _-----Distance from f undation"-,___ .------ J Size: ------------- Diameter- Number iameterP Number of pits--------- ------------Lining material-_ ___. .__ y .-----Distance from nearest well________ _______Distance from foundation___.__..__----'--.Lining material______-..._.___ --------------------- Z Cesspool: = .v-__b - .� Size: Diameter-----4 = == Depth _.; = - .Liquid Capacity-! ------•------------ ---•-gals._ ..� '"❑ .__Distance from nearest building Privy:. Distance from nearest well___- ❑ Distance-to nearest lot line.__---------------------- --- - ----------------- ---------------------------------------------------------------------- �, -. Remodeling and/or repairing (describe ---------------___---- =----------------•------------------------------ ---------•-•-------------- -----------........................................... .1. I hereby certify that I have prepared this application and that the work will be done in accordance with.San Joaquin ounty he ordinances, Stat laws, and rules and regulations of the San Joaquin Local Health District. e or Contractor) E 1. 1 { g ) --- - ----- --- ------ ----- ------•---------------•- (T,tie) (Plot-plan, showing size of lot, location of system in rely ion to wells, buildings, etc., can,be placed on reverse side). FOR DEPARTMENT USE ONLY ~J ------------------ DATE-- APPLICATION ATE-.APPLICATION ACCEPTED BY-_ ._ - �� ----- { DATE------------------------------------------------------------ REVIEWED BY -- BUILDINGPERMIT ISSUED--------------------------------------------------------------------- Alterations and/or recommendations---------------------------------------------------------- -- ----------------------------------------------------------- r -------------------------------------------------------- -------------------- I ------------ /' ---- • -- Date----- =-------- ------ - --------------------- FINAL INSPECTION BYr _---f� -•_ = '�2-� ----------------------- SAN ------------------ n� SAN JOAQUIN LOCAL HEALTH DISTRICT.----------" 814 North "C" Street ' 300 West Oak Street 132 Sycamore Street - 130 South American Street Trac Manteca, California y, California},. Stockton, California Lodi, California tet'*' 09AA Revised W-2100