2527 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. __a -- t� (Complete in Duplicate) Date issued -- to construct and install the work herein described. ---q-S- r � Application is hereby made to the San Joaquin Local Health DiNoc f o.or a permit This application 1s made in compliance with County O - --------------------------------------- ---------------- Phone -Q7 0 JOS ADDRESS AND LOCATION__.-:-_21�i�-- ---Y°=iiY12 - Owner s Name---------lid'-ed-._Brld13Y'S11C ------ •------------- P--3955 - ' Address--------------;��e-----------•------••-=;--•--•-------"- -- ------- Phone------------•----------------- -- -----;----------------------------------------------- -- Contractor's Name_______________��=��'-------------- -------- - - Motel Other ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ ❑ Installation will serve: Residence p Number of living units: __21 , Number of bedrooms __. ___ Number of baths -__1__ Lo# size :--;.- r ------- Water Supply. Public system [:] -Community system 'El.. Private E3: Depth to Water Table _35- It. Clay Loam Gla Adobe� Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ "Sandy Loam- Y ❑ y ❑ Previous Application Made: Yes ❑ No M New Construction: Yes E] No [� +� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) •------------ ----------------- �------------ 4 Septic Tank: Distance from nearest vielL___-_______-- Distance from foundation__________-______- Material- __ E?; TIG No. of compartments_ ___________ T ----Size- ----------------------------Liquid depth--------------------------Capacity----------------------- ______ Disposal Field: Distance from nearest well__ .4Q-�- --Distance from-foundation_____ � Distance to nearest lot line------ ^.------ Q- -r---------.Width of trench.... E Number of lines.----I---------------------------Length of each line________�__-- �I � Type of filter material---_---rQC�-------Depth of filter mater-ial----_1-8-----------Total length--------5Q ------------ Yp s Seepage Pit: Distance to nearest well-------_____________=Distance from foundation___________________Distance #o nearest lot ine______-__________• . Number of pits----- -------- ------Lining material--- ------ -------- Size: Diameter-----•--- -------�- --Depth--------------------------------- El ` Cesspool: Distance from nearest well from foundation-------------------Lining ma erial l- _ ----------------- gals �.: Size: Diameters' ±' --_---'-"Depth = ------ �'�------_= .,.. . .y Y ..— _ + ❑ -------------Distance from nearest building from nearest well--------------------- g ----------------- Privy: ------ � ❑ Distance to nearest lot line--- �-.-•--------------------------------------- --------------------------- ' Remodeling and/or repairing (de ribe}: 5Qr_;�: iQz'_� �i� _ ---10.&.r1h-_.---•--------------------•----------------•-------------------- i ---------------- ------•--------- k -------------------------•--•--------- --------- ----------------------------------------------------- -------------•-------•---•----•-------------------------- hereby certify that I hrulespandaregulatsons elf the San Jaaqum Localwork Heawill lth District. n accordance with San Joaquin County ordinances, State laws, and ------------(Owner and/or Contract (Signed)------------ -D---------C1c3 •-------------,;� ---- ---9--- --------- - Q�=r)^sel--'�tjY' By:-------••-----•------- e 'X' --Y1� 'tn ?--------------------------- ------(Title)--------`-" --•---------��---�---- ---------- -------- ---- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). ' FOR DEPARTMENT USE ONLY ,� _ E__�� DAT --------------------------------=--------------- APPLICATION ACCEPTED BY__ - DATE �--- = REVIEWED BY BUILDING PERMIT ISSUED------------------------------------------------------------- - ---------=----------------------------------------------- DATE _.....W. Alterations and/or recommendations----------------------= --- -------------------------------------------------- - --•-------------------------- ---------•-----------------•----------------------------------------------------------------- ------------------------- - ----------------• ------------------------- - --------------- --------•------- ---------------------------- - --- __ J !/u --------------- Y -------------- Date ----------- - -- FINAL INSPECTION 13Y:__.____ ___ -SAN-JOAQUIN LOCAL HEALTH DISTRICT 132 sycamore Street 814 North "C" Street 130 South American Street $ 300 West Oak Street Tracy, California Lodi. California Manteca, California Stockton"California ES-4-2M 8.51 Revised W-2104 ""