6516 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT / (Complete in Duplicate) Permifi No. �a/n Appfica--ion is hereby made to the San Joaquin Local Health District for a permit to constr Date Issued -__- � This application is made in compliance with County Ordinance No, 549. act and install the work herein described. JOB ADDRESS AND�69CATION__ " 17 Owner's Name ' �► Address ------ �I C� �( .. Phone--- g6 f� Contractor's Name _ " Installation will serve: -------Residence SIt ---` Phone ❑ Apartment House ❑ Commercial ' Number of living units: O�Iumber of bedrooms q ❑ Trailer C� o�� u�❑ Motel ❑ Other _ Water Supply: °Number of baths _/ _ Lot s�ze~_� �� Z PP Y• Public system ------- ,l�J........ ❑ Community system ❑ Private �pe th to Water Table Character of soll to a depth of 3 feet: S��PN P Gravel ❑ Sandy Loam ❑ Clay Loam Previous Application Made: Yes ❑ No ew Construction: Yes 0 No ❑�y � � Ci�� Adobe�'ardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: `" ► "�1 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_ _ Distance from foundation_-"4----""_ No. of compartments" �� Mafierial___- i--- f v. ------ Size- ..__>"' — ro q p 1 Dispol Field: Distance from nearest well-A/ Distancerom foun ion ur e th-_. _-.- Capacity o ___ Number of fines____"""--" ----"-.__.._.Distance to nearest lot line__-_�-_ T e r ;{ Length of each line---- s.0_ ------_---.Width of trench._ �!G�0 YP of fitter material-__-V _ - Depth of filter material_-------16"o _Total length___ D �--------------------- ---- ------ See a e it: Distance to nearest weii___ QQ__�pistanc r Number of its_ m f undation______ __-------.Distance to nearest lot line____.__ p I---------------Lining material" - ' „ ,S____- Cess Cesspool: " - -- -S----Size: Diameter__. _" r �. -"--.Depth � _ p Distance from nearest well---------- Distance from foundafion___________ Lining material------------------------------------- Privy: __""_""".__" " __"" "- " ❑ Size: Diameter-------------------------------------- _____________ ------- ------ --------.Depth-------------- -------------------------------------Liquid Capacity- --•-------------------- rivy: Distance from nearest well ""_-.__""__ "_gals. ------------------------Distance from nearest building Distance to nearest lot line-------"_-"-- 9----------_"-----_-------•----------"-- ------------------------- Remodeling and/or repairing (describe):__-A< --- - - ----- -- -- - ----- ----------------I------------------------------------------------------ /------ -----------------------------"--------•-•------------------------ ------- ----------------- •-•-- ------•----------------------•---------- I here certif that I ave prepared this applicati and that the work will be done in accordance with San Joaquin County ordinances, S e aws, ales nd r gala 'ons of the San Joaquin Local Health District. },� A 'r r (Signed)...... - - -_._- ---- --- ------------------------------ By:---------------------------------------------------- - - e ��r an#ractorJ {Plot plan, showing size of to+, Iota+ion of system in rel io to wells, bt Ings, c., can�bel placed en reverse sideJ. FOR D ARTMENT USE ONL APPLICATION ACCEPTED BY """--_"__" REVIEWED BY--------------------- -- -------- --- DATE-- - --------------------- ------------- UiLD1NG PERMIT ISSUED ----------------------------- -----------•------- DATE------------------------- Alterations and/or recommendations:---------------- - DATE--------------- ---------- ------------------------ --------------- ' ----------------------- -----------------•--- - -- ------------ ----------- FINAL INSPECTION BY_ _7 P G -- T � r - --- --•-- - ----•---• � Date-----------------J- r S . ----------•-----•-- SAN JOAQUIN LOCAL HEALTH DISTRICT �oufh American Street 300 West Oak Street kton, Calinia 132 Sycamore Street for .814 North Lodi, California Manteca, California Tracy, Ce \ —2M , Revised W-2100