2914 - Laserfiche WebLink

Home Browse Search

2 APPLICATION FOR SANITATION PERMIT rmit No. .... M� q- 3-"s Z (Complete in Duplicate] Date Issued `5 o construct and install the work herein described. Joaquin uin Local Health District fora ermit t Application is hereby made +o the San q This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND CAT N -------------------3�� - ---- -95� - =-- Phone ' ------------------- ---------------------------=-------------------------- .Owrier's Name--- ----------- -------------------------------- C� = one. Address-------------- - .- -------- -----------------=--- ---------- - - --------------------------- Motel ❑ Other ❑ Contractor's Name____________ Commercial ❑ Trailer Court ❑ Apartment House ❑ Installation will serve: � Residence p __". - ft. Number of living units: _. __._ Number of bedrooms _. - ri a}e ber D pthh+o-Watao Table Community system ❑ P Hardpan Water Supply: Public system ❑ Gravel ❑ Sandy oam ❑ Clay Loam ❑ Clay ❑ Adob P ❑ Character of soil to a depth of 3 feet: Sand ❑ ew Construction: Yes No C]Previous Application Made: Yes El ,N , TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public s w r is available within 200 feet.) J _ Materi _-- Distance from f undat' n � ----------------- Distance from nearest wet} 4 j Y---- �--- � p � - Ca acct - Septic.Tank: "-_-_---Size -.-• Liquid depth-__, --�- - - No. of compartments_.. ------ ._Distance from foundation Width to nearest lot line----------------- ell Field: Distance from nearest well..."_..__.___-- Number of fines--------------- ----- "-- ------ --Length of each line------------------------------Width of trent ----------------------------------- Disposal ------------- ------------------ ❑ Depth of filter material------------------- - - tel length_-----.---------------- Type of filter materia4-------------------� p istan e to nearest lot lin • Distance fr m fQ <3 ti Dia -- ---------- Seepa e Pit: Distance to nearest well��"-g --Size: Dia eter.. - _----- ----Depth ---- Number of pits----•- ---------- Linin materia o - ------------Liquid Capacity----------------------------gals. Distance from nearest we4L._"-------------D'istance from foundstion-_.__----------------L1e1Rg matena___"_---------.............. Cesspool: --De th---------------- Size: Diameter-------------------------- ------"-_---Distance from nearest building--------------------------- Distance _------"------- ----------------------- 0 --- ---- Distance from nearest we _.------------------------------------------------ ---- ------------"-" . ----------- Privy: -------------------- --------- �.�,,,_ ❑ - Distance to nearest lot ine._".______-- ---------------------------- describe ------------------•---- Remodeling and/or repairing - --------------- -----•---------------- ------------------------------------------------------------------- r ' that I ha prepared this application andipaauthe oca! HealtheDi District. ordinances, accordance with San .loaquin County I hereby ce regulations of the San q ordinances, S4 a laws, and ule3 arP��re9 (Owner and f or C ntrac#orl ---- -- - ------------------- ---------- ---- ---------- ---------- ---- --------------(Title ------ (Signed) - - - ----- ----------- -•- /� BY-------------- -----v'- n showings a of lot, ocation of system in relation to wells, buildings, etc., can be paced on reverse side}. (Plot plan, FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED. BY."_ --- -- --------------- ------"---- ----------------------------- -------- DATE..,.-�---------------�----------------------"----- -- DATE----=�---------- -------------------•------------- REVIEWEDBY---------------------------------- , --- --------------------------------------------------------------------------------------- DATE----------^.---------------------------------------- - l - s---------- _ - BUILDING PERMIT ISSUED---------------------------- ---- ---- ------- -- --- ------- f---- �`------- -6-------- ------ ---- .Altera ns and/or recomrnens3ations:--------- -* -- a �� ." - : - . .. r ----------------•------ ------------------- ------------------------------- --- ------------------------------------------------ ----------- -------------.- ---- ----/ ------- --------- ----- ----------- --------------- FINAL INSPECTION BY:.---------� - - = ---- Date_- ---- - --- ---- - SAN JOAQUIN LOCAL HEALTH DISTRICT 814 North '•C" Street 132 Sycamore Street Tracy, California 300 West Oak Street Manteca, California 130 South American Street Lodi, California S+ock+on, California L$-9-2M B•51 Revised W-2100 s