7566 - Laserfiche WebLink

Home Browse Search

itNo. ................•------ APPLICATION FOR SANITATION PERMIT Perm �G Complete in Duplicate) Date issued ---- • made to the San Joaquin Local Health District for a permit to construct and install the work herein described. Applica*ion is hereby s This application is made in compliance with County Ordinance No. 549. Phone--------------------•--------------- -------------•---•------- JOB ADDRESS AND LOCATION-----�-�-Q--4�__._�r.�__�A,D-�_ -.-- -- -•- - ----- ----- ---- ------ ------- -- ---- Gc) ,<� [ .nt - ------------------------ Owner's Name----------------•=------ -- -------- --•----------------------------- ,1.—M ��--------------•----------------•------------------------ Phone ---------------------------- Address----------------------- ---- -------------------------- - ------------------------------ - Contractor's Name---------- Trailer Court ❑ Motel ❑ Other ❑ Installation will serve: Residence Apartment House ❑ Commercial ❑ % X 1-Z a f --- Number of living units: ----/__ Number of bedrooms ----- Nue be�� baths o WaterTable ------- ft- Public system ❑ Community system ❑ Adobe�}�ardpan ❑ V Water Supply: Y Clay Loam ❑ Clay ❑ Gravel ❑ Sandy Loam ❑ Y Character of soil to a depth of 3 feet: Sand ❑ ew Construction: Yes E] No �� Q Previous Application Made: Yes ❑ No [5� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet. t, --------------------------------ndatLiquid depth - Ca ati - - ---------------= ----Materia-------------------------------------------------- Distance ---------- ------ Septic Tank: Distance from nearest well_________________Distance from foundation------------------- �Capacity l/ ❑ 01`01x( No. of compartments_---.___------------ -SizeZ� f -Distance to nearest lot line____•--_.---- p�_----------Width of french----- .//---------- Disposal Field: Distance from nearest well-_-k.10_1--- Distance ofrom each line-a_sow-�----- ©� Number of lines------------ �t g -- Total length Type of filter material___ _,F___>S-t '- Depth of filter material._-_. � - Distance to nearest lot line______________ __ .,Size: Diameter---------------------- Depth_----------------------- = r Seepage Pit: Distance to nearest well---------------------Distance from foundation ❑ Number of pits---- ---------- ----Lining material ------------------------ Distance from nearest well-----------------Distance from foundation.__._._._..-_-----.Lining material_._--------------------------------- Cesspool: ____-- gals. Cesspool: _De #h------------------------------------------------ 0 ---�------------ ----------- ----- ------ ---------Liquid Capacity- -------------------------- p ❑ Size: Diameter---------------- - Distance from nearest well------------- ------ ---- -------------------- -Distance from nearest building---------------- --------------------- - Privy: ------------ -------------- ----------------------------------------------------- ❑ Distance to nearest lot line----------------------------- --- � � Remodeling and/or repairing (descri e):__-- -- -- ------------------------------------------------------ -- i --` ------------------- ----------------- have prepared this application and that the work will be done in accordance with San Joaquin County I hereby certify that I prepared ordinances, Stat laws, and rules and regulations of the San Joaquin Local Health District. ( her and/or Contractor) S -------------- - tl `------------------- ----------------- --------------------------------------------------- (Signed) - -(TI e) - ------------------- 9 (Plot pian, showing size of lot, location of system in relation to wells, buildin s, etc., can be placed on reverse sl e. FOR DEPARTMENT USE ONLY ---------------- DATE - ----•----------------------- DATE ,J.PPLICATION ACCEPTED BY------ - -- ------ -- ------ ---- ------------------ -------------- --------------- -"`--� REVIEWED BY ---- ------------- - --- ----------- ----------------- DATE------ ------ ----------------------------------------------------------- BUILDING PERMIT ISSUED-------------------------------- -------------------------------------------------- �...__.._ ------------------------ - - ------ -----:----- Alterations and/or recommendations:-_____-------------- --------------•------- � �]]'`` ---- -------------•----•-- U" - - ----------------------------------------------•---•----- - ----------------------- --------- C, ----•--------------------------- .5�.� Date..._ _�lk �- ------------ FINAL INSPECTION By:-.- -------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street 300 West Oak Street Tracy, California 130 South American Street Lodi, California Manteca, California Stockton, California i 4 46 AYWOOd E5-9-2M 1454