10829 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. _/Al--�- --_Duplicate) � (Complete in Du S p 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 with County Ordinance No. 549. JOB ADDRESS AND LOCATION•-----..� 7-------- -d-------------- J------ ®------ Owner's Name--------- v-�/ 1W-A4---- /4/ Phone `----- �J 7 Address-.---------- -_s--------- -----------------------`--------------------------------------------------------------------------------------- ------------------------------------ - 9iZ Contractor's Name-------------�� --------- --- -- 1_cS�'---PE...5��4/--- ��'------------------- ----------•--- Phone-,�•� - --� Installation will serve: Residence, Apartment House ❑ Commercial [] Trailer Court ❑ Motel ❑ Other ❑ f7 - � ----------------- Private - I Number of living units: ___�._- Number of bedrooms�_-_ Number of-baths _ ______ Lot sixe _____ +�-�-----••------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table '+ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Madel, Yes ElNoX New Construction: Yes E] No FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: E .' (No septic tank or`cesspool permitted if public sewer is available within 200 feet.) 1. S is rta x Distance from nearest well-__---____--_--Distance from foundation--------------------Material_-___.__-_----.-_..-------.-_--_--_----.--_----- -_Li uid de th--------------------- Ca acit ------ No. of"compartments ---'---- =-----------Size-----------------------•------ q R -'- Capacity _.. - I l�islso ie Distance from nearest well------------------Distance from foundation--------------------Distance to nearest lot line-__----_--.--..T Number of lines---------------- --Length of each line----------------•------5------Width of trench-------•------------------•------- T I Type o7 filter material_______________________,Depth of filter material------------ -----Total length-----------.______ ._.___________-...---:- Distance�m foundation_._ ___.Distance to nearest lot line__ y Se . age Pit: Distance to nearest well__,C��__.___._ 1� - .—"�''�----- Number of pits______ _ Lining material_. .C, ._-Size: Diameter-___. _-__..._-..Depth__. ------------------- C sspool: Distance from nearest well----..-_____-._-Distance from foundation------------- .____.Lining material------------------------------------- I ❑ Size: Diameter---- -- ------------------ ----------Depth_-------------------------------------------------- Liquid Capacity ' ' gals. ` 1 V Privy: Distance from nearest well------------------_--__---_ --------------Distarce from nearest building------------------------------ ------------------------------------------------ ❑ Distance to nearestlat line-----------------------' ----------------- ------- -------- ------ Remodeling and/or repairing (describe]:___,. - } - �� ------ - -------------------------- --------------------------------------- ��l e`1{ ------ -------------------------------------------- -----------------------------------------------------------------------------• ----------------- r l hereby certify th I „have prepared this application and that the work will be done`in accordance with-San Joaquin County ordinances, State law d r s a re ulations ofithe San Joaquin Local Health District. ' -- (Owner and/or Contractor) (Signed) ---- -------------- - ------ ---- ----- ----------------- -- --- - ---------------------------- �Lc -------------------(Tit (Plot plan, showing size of,lot, location of system in reh tion.to wes, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY 1 - ----------------------------------------------------- DATE------------- I� f ��'# -----------------' REVIEWEDBY------------- -----`----- ------ ----------------------- ------- DATE BUILDINGPERMIT ISSUED-------------------------------------------------------------------------------- DATE Alterations and/or recommendations----------- ------------------------------------------------------------------------------------•-•-------------------------- ----•--------------------------- I _ _______ __ ------------------------- --- =_=___: k_____--------------------- �-____ - _ ---------------------------_:__--.- - ---------: :: . ______________ -----------------------------.___--_--------------------.----------------------------------.--------------- ------- ii FINAL fNSPECTION Date r l y --------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stoekton, California Lodi, California Manteca, California Tracy, California ES-9-21x1 Revised 1-57 F.P.CO.