7810 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. ......-.._ (Complete in Duplicate) Date `Issued ...7/z_�� 1 Applica4-ion is hereby made to the San Joaquin Local Health District-for a permit to construct and install the work herein described. r This application is made in compliance with County Ordinance No. 549. �JQB ADDRESS AND LOC ATIO __--�-. S .o-.----[IL'-- -- ---�V- S-h t ri �-,Cao ' � -�- - •---------��---�-tib-��------- --- --------------------------------------------- - --- Owners Name..I ----------------------------- Phone. ��© �-�`Z, �__l Cont actors Name_.-.-.1 o T ti `m 9 e/- ----•-----------•--•---- -------------------------------------•---------•--- Phone- --~------------------- Installation will serve: Residence 'W Apartment House E] Commercial E] Trailer Court E] Motel ❑ ❑r Other ' Number of living units: S7 Number of bedrooms -..:2--- Number of baths .3-.- Lot size Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Table 17_ \ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [v/ Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No D�/ TYPE OF INSTALLATION AND SPECIFICATIONS: ! (No septic tank or cesspool permitted if public sewer is available within 200 feet.) p ---------------Liquid depth--------------------- Ca S ti� Dot of compartments well.....:.....:.... Distance from foundation..._.-._._..--_-_-.Material...-_--.... .. �' pacify----------- -------- D ------- � Dispos hFi!.Id: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line.._.._-._........ a Number of lines-------------------- - --- ------Length of each line------------------ Wi hof trench Type of filter ''material------------------------Depth of filter material...-----------.-.-_-..Total n th-----.1�_ --------------------------------- See a Pit: Distance to nearest well �` p -.-.Distance from�oun ation. -----Distaprce to nearesf. I f Imp.. ........... Number of pits---------�----------Lining mater,, ACCASize: Diameter- ------------Deptn__-tx-- _-------------- Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Liningmaterial .'l •------••-- ` ❑ Size: Diameter--------------------------------------Depth---------------- - - - -------- - ---- -------Liquid Capacity!,--------------------------gals. ,Privy: Distance from nearest well---.....----------------------------------------Distance from nearest building__-.- .------ ❑ Distance to nearest lot lire-------- �_ __ scribe):__` � Remodelin and/or repairing d _....--0�✓✓�C-i�' C�� iJry' <__� t f-pl .--...-•-----t--'-V-r-'s--------------------------------------• -------------------------------------- -------------------------- -------------------------------------------------------------------------------------------- -------------------------------------------------------------....------------------------------ ! hereby c if #hat4rand pared this ap cation and th the work will be done in accordance with San Joaquin County ordinances, St .e ws, aregulation of the San Jo uin Local Health District, 11 (Signed) �� '_ f - - Contra By ((Plot plan. sho ' size of (Title) a--- . ------ p on system in relation to wells, buildings, etc., can be placed on reverse side). ) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ------------- ----- 7---- ------------ -------------------------------------------- REVIEWEDBY-------------------------------- - ------- ---- --------------------------I------- --------------------- ------.- DATE----- -- BUILDING PERMIT ISSUED-------------------------- ---- -------------------------- -------------------- --------- DATE...------------- --- ---{{ Alterations and/or recommendations:_-------- - - :----------- U ------------•-------------------------------------------------•------------------------•------------------------------------ ----••-------------•-----------••---------------------•---------- ------------------------------------------------------ _--. -------------------------- --------------------------------------------------------------- ------------ � � 7 7 IAL INSPECTION BY:..--------- r --- Date..........--f--------- �G f z ---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wesf Oak Street 132 Sycamore Street 814 North "C" S' Stoefc+on, California Lodi, California Manteca, California Tracy, Califon ES�9-2M �Ilasaa6 aTw000 12-54 --