2356 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit N (Complete in Duplicate) Date Issue M� S Application .is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein describe This applicafion is made in compliance with Courify Ordinance No. 549. JOB ADDRESS AND LOCATION[°--------5-OX6_p--------2�2Q_'��_�'� ��.Qo---�3,c1_�_ Owner's Name =Jia,--� 3Y3C'1' } --------------------------------------------- Phone_-;�--28.65--------------- Address ---•----:----2711r�--'S-a-•.l�.i�1S_QXl---------- -------- J __________________________________________________________ on ractor's Name=---------'--------D-6�G�----•------------------- -- -•------- - -------------------------------I will serve: Residence [I Apartment House C] Commercial r D. Trailer Court Number of living units: .__O--,Number of bedrooms .__Q-- Number of baths ❑ Mo+el ❑ Other ( ,S.-�.,1�, Lot size ---SQc�6Q 110u ae Water ,Supply: Public system ----- -----a; �_ Y [ Community system 0 Private ❑ Depth to Water Table ___.___" ft. ---------------------- Character of of soil to a depth of 3 feet: Sand ❑ Gravel C] Sandy Loam [] Cla Loam Previous Application Made: Yes No Y ❑ Clay ❑ Adobes Hardpan ❑ ® New Construction: Yes ❑ No � � ' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ; Septic Tank: Distance from nearest well-----------------Distance from foundationy___."_Material___________________- ;� 1EXIS�iTG No. of compartments_ _ _ _7k-. .-= ------------ T _ Size---=-----"--------------------Liquid depth---- DisposalCapacity, -,i Number of lines -_------ - Distance from fou dation __ D anc'to-nearest lot 1�r3 Field: Distance from nearest well_________________ ---------Length of each line---- .Width of trench Y � -�--M! Type of filter materiaf______ __ _-__Depth of filter ma#erial_______ _ Seepage Pit: Distance to nearest well -"_-_ Total length_"________"--__-- _-----------1� _.______Distance from foundation_2t______________Distance to nearest lot line__"___2_'------ Cesspool- __._�~t X] Number of pits--_-__�---------------Lining material__briol;--------Size: to •_ - � s Cess ool: -4----------Depth P Distance from nearest well-_______________Distance from foundation------------------Lining material_______._-_...__._________--___-_-_ ❑ Size: Diameter--------------------- -----Depth----------------. Liquid Capacity _" }u ---gals. V ' Privy: -Distance from nearest well--------------------------------------------- .___Distance from nearest buifding❑ Distance to nearest lot line--_-------- ---- --------- ---------------------.------ ------------------------------------ Remodeling and/or.repairing (describe:_-_---Instal—li--, ._120 f__3.7 C' _iC_e- __ 16 Y°a]Y]'_--C3t7]'y----•--•--- - --------------------- -------- ----- ------ ----- -- --- -- -- -- ------ --- - ---------------- -- --- ------ - - - -------- I hereby certify that I have prepared this application and that the work will be done in accordance with San J-04-quip Count ordinances, State laws, and rules and regulations of the San Joaquin Local Health Disfrict. y (Signed)--------------------._0_�, (Owner and/or Contractor By:-----------Parrir_.trd�' -I 'r?�,il.---- -- -r-� - _ _ Tit (Plot plan, showing size of lot, location of system in relation to wells, buildings,>etc., can( placed on reverse de). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ --------------------------- ,BUILDING --- -DATE- / REVIEWED BY-•--- --------------------•----_. - - - � - -- ------------------------ --------------------------------------------------- BUILDING. PERMIT ISSUED - DATE__._.__ �- . Alterations. and/or recommendations DATE-------•_"- q - ------------ -------- ------------ ------------ --------------------------------- - ------------------- -------------------- FINAL INSPECTION BY:--_--"- - -_"- �" ,,, --------- ---•------------- - Date--- --• - ---- - --� —--- € SAN JOAQUIN LOCAL HEALTH DISTRICT d+ 130 South American Street # 30D West Oe1< S}reef 132 Sycamore Street Stoc[<ton, California Lodi, California _ 814 North "C" S}rest Manteca, California Tracy, California l-5-9 –2M 8-51 Revised W-2=