4288 - Laserfiche WebLink

Home Browse Search

s APPLICATION FOR SANITATION PERMIT Permit No. _ _.--+� ----�----- [Complete in Du Licata 4 3 4 Duplicate)} Date Issued -- -- --- - --- ---- ork herein described. permit to construct and install the w a Application is hereby made to the San Joaquin Local Health District for p t This application is made in compliance with County Ordinance No. 549. i �' �JOB ADDRESS AND LOCATION_____ ---4_7_ -- Phone--- - Owner's ame------------- -- -------- - -- ---- - ---- - --------------------•- Address --- ----- Contractor's Name------ Installation will serve: Residence ❑ Apartment House [I Commercial ❑ Trailer Cour} [:jMote1 ❑ Other Number of baths __-�-- tot size -------a: l Number of living units: _3- Number of bedrooms _"� Depth to Water Table+® ft. Water Supply; Public system Community system ❑ Private E] p Pp y' Cla Loam Clay C] Adobe Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ �Y ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) nm�------------------ 44, Septic Tank: Distance from ;nearest well------------------�Ze � fyA)(,C!� iu dd epth -M�- q- ----.---Capacity__./- a- -- No. of compartments_____- 1 r r< Disposal Field: Distance from nearest welL_______________ 79 _Dlstance from foundation-__�07-_t to nearest lot line--___ _____-. Length of each line . 0 i7--,Width of trench-----2- ---------------------- Number --- ------------------ �. Number of lines__________ -".-_-- -._ Type of filter material t_ ---Depth-of—fil material__-.___f----------"_Total length-------.yd----• Seeps e Pit: Distance to nearest well______________________Di fiance from fou 9 'on_____ -® .----.Distance tonearestIoaiine�----------- Number _--.- -- -- i Number of pits--------I-----------Lining mat 'al_s�. . S' e: Diameter______ p ing Cesspool: Distance from nearest well_________________Dir#ante from oundation-__----------- " Linuid Capacity gals. ❑ Size: Diameter--------------------------- ----------Depth_"---------------------------------- -------- g p Y 1 Distance from nearest building---------------------------------------- Privy: Distance from nearest well----------------------- ----------------------------------------- ❑ Distance to nearest lot line------------------------------------ ------- --- -------------- -- Remodeling and/or repairing (describe):______.__.__-___--------------- -- --------------------------- --•------------------- •-------------------------------- �----------------•----------------------- - --------------------------------------------------------------- --------- -------- - --- - -- --•------------------- -------•-----------------------_---•- I hereby certify that-I have prepared this application and that the work will be done in accordance with San Joaquin Coun ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. k wrier and/or Contractor} (Signed)_ - ------------------------------ ------------- • Title}--- ------ ------- By= e-0 . (Plot plan, showing.sizelot --- cation of stem in relation to wells, buildings, etc., can be placed on reverse side}. 1 FO D RTMENT USE ONLY j ------------------- DATE- " I APPLICATION ACCEPTED BY- ---------- ----------- : REVIEWED BY--------"---------------- -:-----•--------------- ---------------------------------- ------------ DATE----------------------------- --------•------------------• BUILDING PERMIT ISSUE -------•--------------------------------------------------------------- ------ --------•------------------------------- Alterations and/or recommen afians:_____".__.___"__._.- -- • -_-•_--__••__________________ ------------------------------------------------------------------------------ a, ---------------------------------------------- ------------- ------------------------ --------------------------------- FINAL INSPECTION BY:.------ -- lh Date 1 SAN JOAQUIN LOCAL HEALTH DISTRICT i ' 300 Wast Oak Street 132 Sycamore Street814 North "C" Street 1. 130 South American Street Manteca. California Tracy, California Stockton, California Lodi, California 1 k ES-9-2M 10-52 Revised W-2100_