6507 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT �R �.� P ermit No. .--•- -•------- [Complete in Duplicate] �•� /� .�I S� Date Issued .____. g plica¢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 witfh County Ordinance No. 549, JOB ADDRESS AND OCATI N_____- __C/_ _ f - - -- r _ Owner's j Name.-----Address --- --�",J-------- Ph one-•--------------------------------- -- -------------- `Contractor's Name____._._ _` Phone'il�� s�.2�/�► Installation will serve: Residence 7 Apartment House ❑ Commercial ❑ Trailer Court [] Motel [I Other ID Number of living units: /___ Number of bedrooms 3__. Number of baths --/- ]Lot,size __/1-10_ - 11;!A -------------- Water Supply: Public system X Community system ❑ Private ❑ Depth to Water Table 4_ t. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe'0 Hardpan ❑ Previous Application Made: -Yes ❑ No New Construction: Yesg No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public ;ewor is available within 200 feet.) Septic Tank: Distance from nearest well )UgWisfance from founds#ion__ 1d.-'---.i1�te;ia`_4_,.�• i No. of compartments . I Size--------Liquid depth.- - Capacity `s d Disposal Field: Distance-from nearest well IO, X Distance from foundation_ _ --__ __.__._..Distance to nearest lot line-s____-,•-_- Number of lines______-/__ - __ __ Length of each line_----75 i Width of trench___.-y--"------------- Type of filter material r- �F Depth of fifter materia!___ -_-----.---Total length---.-7, ----------------- - i Seepage Pit: Distanceao nearest weir-- __ Distance from foun ation____%5- ----- Distance to nearest lot line-___`s. --- j �f Number of pits------ materialic $ize: Diameter._3..3�� Depth.-. pC-C1 Cesspool: Distance,from.nearest well--------------___Distance from foundation----------------- Lining material-----------._._--._.__-_____--._____-. ❑ Size: Diameter -----------Depth -------------------------- -----------------Liquid Capacity-.--------------------------gals. Privy:: Distance..from nearest well__________________ __________ --------------------Distance from nearest building--------------------------•-------------- ❑ Distance`-to nearest lot line-----------------------------•--------------- ------------------------------- - Remodeling and/or repairing describe]_------------------__-.___-_-_____.._._ that ed this ordinances,b5taf.e laws, an have s ands regulations application the San JoaquinLocalL cal Hee work all lth h done in accordance with San Joaquin County / q h Drstrrc+. (Signed) .� ��- ---------- ---- ---- �.__Iownd/or Contra +or== - rI tle)-�-(Plot plan, showing size of lot; location of , em in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-9------------_ .--------........ - ' REVIEWED 13Y T%, -Z7- DATE- - - �--- ----- -------- ------ ------------ --------------- •--------------•- ----- DATE----�r----------------- ------------ ---------- BUILDING PERMIT ISSUED.-----------------------'-------- DATE r Alterations and/or recommendations--------------------------- - ------ ------------------ -- ----- ------------------•---- .--- ---------------------------------------- ------------------- FINAL INSPECTION BY:----" ----- ------------ Date------L� , - - --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Sfock+on, California Lodi, California Manteca, California Tracy, California ES-9-2M 145446 ATwoao 12-s4