10635 - Laserfiche WebLink

Home Browse Search

�w APPLICATION FOR SANITATION PERMIT Permit No. __ -- --- (Complete in Duplicate) Date issued Application 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 h County Ordinance No. 544. . `/ lc``e, ----- � z + JOB ADDRESS ANtil;_B OCATION_.,. �•.------- kt ` wiy }�_ __, - - f� r �� --------- --------- Phone------------------------------------ -1 Name----- - -------'`-i--_ �.:.- -_----��-��4_11.,��'----------- --------- Address---------- --- -------------------------- ----------------- Ilcc V V_`- 6� = � Gj-, ��( - Phone---kca-_------ �/ Contractors Name------ _k ___ Installation will serve: Residen t}e a�Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1____ Number of bedrooms _�-1___._ Number of baths _ -_ Lot size ______ --------------------- Water Supply: Public system 0-1c"ommunity system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe O_--iTardpan ❑ Previous Application Made: Yes ❑ No ❑/New Construction: Yes El"No ❑ FHA/VA: Yes ❑ No ❑--' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 244 feet.i Material_ �� tf�------------------ Septic Tank: Distance from nearest well --_-Dista�e from fou�ation_��___------- Ca aci %-------- No. of compartments------�' --` k- , C---,- -.-__Li uid de th_____' ----------------- p ty---K-= ❑/ Size - q P. Disposal Field: Distance from nearest well__L�~ Distance from foundation__' _- ----------Distance to nearest lot line------- ____.-__ Number of lines------i -------------------------Length of each line------- . '----E----------Width of trench_ _'{__------------------------ Type of filter material_-(- --------Depth of filter material--- -- --------.Total length------- ------------------------- \(\ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------.-----------Distance to nearest lot line----------------- ❑ Number of pits----------------------Lining material---------------------- Size: Diameter-----------------------Deptn-------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation_-------------------Lining material----_.________----------------- al-- T" F1Size: Diameter--------------------------------------Depth------------------------------------------------ ---Liquid Capacity----------------------------g Privy: Distance from nearest well--------------------------------- ---------- .-Distance from nearest building------------- --------- ----------------- ❑ --------------------------------------------------------------------- Distance to nearest lot lire------------------------------------------------ Remodeling and/or repairing (describe :-------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------•--------------------------------------------------------------------------- ----------- ------------------------------------------------------------------ -------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State-,I6r s, rind rules and regulation's of the San Joaqu' Local Health District. �a1---------------------------------------------------------------(Owner and/or Contractor) Si ned _._ __ ��``- - ( 9 i BY= -- --------------- ----------------------------------------------- ------------------------------.-(Title)---------------------------------------------------------------- -- - -- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- :_3<t Y- ' ~`---------------------------------------------------------- DATE---- :"---2�------- ----------------------------- REVIEWEDBY----------------------------- - - - --------------------------- DATE----------------------------------------------------------- BUILDING PERMIT ISSUED--------------•------------------------------------- ----------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:---------------------------- -------- ---------------------------- ---------------------- ----•------• --------------------------- ZVO-- ,DF-----1- C,I4------z-)-htES-------- ----Tom- 4---r--------- -rv��.------ N.1- --------«-------b'B Fl u' � ' T-7 _FLAG -------WA-5------ x K- ,R-o'--------------- --�Z `ao,�,-- TAL 1 = N falx Tf3_taK N0---- �_TTo'±'I n `tr�t1; � T�AcT t�------._51%�--------fJ------ --�ouL.'D-------�o I Mr1 'TIN WHIU�H M_A_ t_r4 � VI - WAy I K Fr=W PAS • /�=N 3- -------------------------------------------- PIN � c BY: -- ------- sRDate '. CONTRACMF, SRys caAN JOAQUIN LOCAL HEALTH DISTRICT nlclKETl_ UJA5 1ovR 13?3T?cu M O� " A t4KS 132 Sycamore Street 814 North "C" Street !36 South Ameriaen Stree 300 West yak Street Y _57 5toekton, California p,K - Lodi, California Manteca, California Tracy, California t E5-9-2M Revised 1.57 FY.CO.