5981 - Laserfiche WebLink

Home Browse Search

II211 APPLICATION FOR SANITATION PERMIT Permit No. ___ _______ (Complete in Duplicate) •- Date Issued Applical-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 with County Ordinance No. 549. - , JOB ADDRESS AND LOCATION----`--------7-12-----------tv----�----� .D-�/ '----------------- .._ = -------- ------------- - Phone--- -------------------------- Owner's Name----•----------*�-Ea/��-`=-`-===�'Q_��f 7?_Q_.- =----------- =----- ------ -------------- ----- .�. I - ----------- --•----- Contractor's„Name-------r-------------------- il\-----& f�---- --'-'=--=-------------:--------------------- ---------•--------••----:----- Phone _ t ---------------- Installation will serve: Residence 9- Apar"tment House ❑ Commercial ❑ Trailer Coulirt ❑ Motel ❑ Other ❑' Number of living units: ________ Number of bedrooms Number of baths ___I___ Lot size --------5--v------ f< Water Supply:"Public system X Community system ElPriv!e E] Depth to Water T able -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam�❑ Clay ❑ Adobe)K Hardpan ❑ Previous A plication Made: Yes ❑ No New Construction: Yes F,40 ❑ TYPE-OF INSTALLATION AND SPECIFICATIONS: I P pool permitted if public sewer is available within 200 feet.)- Na septic tank;or cess - Septic Tank: Distance from nearest well_____________Distance from foundation____ ____________Materral_______ ______ ________________. f No, of compartments._.__-- i �� air """/ Size X •fir Liqurd depth Capacity_.. --- - Dispos k Field: Distance from nearest weak----�' _.-._Distance from founc3ation___._' Distance to nearest lot line_-_..�'______. Number of lines------------57--"---j-------------Length of each line--- �_ 1)/-.!hA-Width of trench----------- ------------------ Type ----------------- T e of filter material"-_-__ l y De th of:filter material___ __ !�_Total kength______.__ _�7 ___________._____._ yp p See a e Pit: Distance to nearest well_-_________________:_Distance :from foundafion..--�_______=_.__.Distance to nearest lot line____----__-______ p .g ❑ Number of pits----------------"-_.""Lining material:=---------------------Size: Diameter----- .N C Depth------------------ Cesspool. Distance from nearest well------ ___Distancelfrom foundation--------------�1 ..Lining material-_ _----- Liquid-Cgppcif ------- --- - ------gals.— __ � --- - - - Lance from nearest well-..---- --------- ---- Distance from nearest building------------------------------------ Dis --------- . Privy:: Distance to nearest lot line---------- =--------------�- -- -- - !� ❑ I - Remodeling and/or repairing (describe):---------____________________-__ • ___ _-:- • =---------- ----------••--------------------------------- _ - Hl - --- -----------------------__-•------------------•---------------•----------------------------- ------------------------------------------------•-•----------------- .. _ __________ _____________ ________________•______--________________________________-__________________ ------------------.__ _.________________-__-__.f___.____._____ ___________.___.__.________-_-_________ - _____.-__ I hereby certify that I have prepared this application-and-tha+.the work will be done in accordance with San Joaquin County ordinances, State 11a an rules and regulations of the San Joaquin Local Health District. C', f 40) - -----------------------------------i---------------------(Owner and/or Contractor) (Signed)---•---��-=---- - --d -----C�-ti•�'------------------- .� --------------(Tit ------•-------------------- ------------------ le__ I (Plot plan, showing size of lot, location of system in relation to we11s, buildings, etc., can be placed on reverse side). lE FOR DEPARTMENT USE ONLY --------------- PATE------------ - APPLICATION ACCEPTED BY--- --------------------------------- - ---------- --- ,k _ - --------- DATE REVIEWED BY---------------------- ------------------- -- BUILDING PERMIT ISSUED------•------------fi -- -------•-------- `----- -- --} ------•- -- -------------- --------- - i ATE-- --- -�-------------------------- ------------- - _.. -..-_,...r,,,w,„�.,--."=--"-•---- ------------------------------------------------------------------ Alterations and/or recommendations:' ____-:� _"�"'-- ------ : --•-------- ----------- --- - ' --- - _.---- - - - - --------- ------ -----•--- ------•----- --- ---- ---------- ------------- ------------------------ n- --- --------------- F ----------------- ---- ------ ------------------------- l NAL INSPECTION BY:_- - Date --- SAN ,TH DISTRICT I 132 5 cemore Street $14 North "C" Street 130 South American Street 300 West Oak Street Y y Lodi, California Manteca, California' Tracy, California Stockton, California - ES---9-2M Revised W-210Q 1