5557 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. j5--- (Complete in Duplicate) bate Issued Applica*ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the rein described. This a plication is made in compliance with County Ordinance No. 549. _ y �j�{� 14e �. I a Q e - a ------ JOB ADDRESS AND LOCATION r """" 6� $�✓ t Phone-- fll ---- ------- l' z Owners Name_ ------- ------ Address__ -i'_ _- / --- ---- ---------------------------------- --� Phone'7�'�Z1.:G��1Q-�� Contractor's Name--------------- ----- ------ .SJR ••.2 �. Installation will serve: Residence Apartment House Commercial ❑ ❑ ' Trailer Court Motel Other ❑ a- Number of living units: /P'A' _ .. of bed s _ _ Number of bathsl�_-__ Lot size i Water Supply: Public system F1Community'system ❑ Private,K Depth to Water Table -------- ft. ? Character of soil to a depth of 3 feet:, Sand E] Gravel ❑ Sandy Loam Clay Loam F1 Clay E`Ad ❑ Hardpan El Previous Application Made: Yest4 No E]- New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank,or cesspool'permitted if public sewer is available within 200 feet.) t i 5e c Tank' Distance from dearest well------------- ---Distance from foundation-------------------_Material-------------------------------------------------- t` No. of compartments------ - - Size-------------------------------Liquid depth Capacity • . . --Distance from foundation__�_P r------.Disfance to nearest lot line.-Za--f Tsposal Field: Distance from nearest well_ -- Len'th of each line____ ____.Width of trench___ �-------------- T - 7�t Number of lines------- ----- 9 - T ti" / ` -------- �--- �} _Total len th--��- - --------------- dType of filter material._-�---� c,---Depth of filter material___ -� " ----- 9 Seepage Pit: Distance to'nearest�well___________________---Distance from foundation---------- ------Distance to nearest lot line_______.__-"___+ ❑ Number of pits Lining material Size: Diameter----------------------Depth------------------ Cess ool: Distance'from nearest well_____________"._"Distance from foundation-------------- Lining material__._.______.-_.______.__- _ p -_Depth ------- --- --- --- -- Liquid _ _.- �- - - Size Diameter__ --------------- El - — -_- ""_ Cap a �ce building �. : . —� Pri —Distance-from,nearest well-------------------------------------- -- Distan from nearest -- Iy: -----------------------------------------------" -/Disfanle to nearest lot ine________. ------------------------------- ------ ------------- -------......j-Y- 4- 1 E ,► Remodeling and%or repairing (describe):___" rt ---- ------ &---='- ."-=s ---- -- --- I f ---•------------------------------------------------ ---- T - -------------�------------------------------------------ hereby certify that I have prepay this application and that +he work will be done in accordance with San Joaquin Cto oun+� ordinance ate. ws; and rule and r g lations of th San Joaquin Local H alth District. Contractor) ------------- --- -- ------ --- - (Signed) ----- - - �a=(Title)- �77 - " 14�- (Plot plan, showing size of lot, location of system in rel do o wells, buildings, et ., can be placed on reverse side). '~ FOR DEPARTMENT USE ONLY r DATE----------- ! > 'J----511,---------------- APPLICATION ACCEPTED BY-------------.---------_---------------------------- ----------------•-- ------- DATE------ ----------- REVIEWED BY- ----------------------------- ---- ----- ----------------------------------------------------------------------•-----------• DATE--------•-------•-------- -------------•-----------•------- BUILDING PERMIT ISSUED---------------------------------------------------------------•---------------------- Alterations and/or recommendations:____________ __._____.._----------------- •------------ ---------------------------------------------------- ----- - ------------ -------------------------------------------- ------ ------------------------------------------ -------------------------------------- i- ---------------• ---- Date------------ = --•--------------- FINAL INSPECTION BY:_-_-- ----rte ` ---- --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street 130 South American Street 300 West Oak Street Manteca, California Tracy, California Stockton, California Lodi, California ES-9-2M ; Revised W-2100