8954 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT, Permit No. (Complete in Duplicate) Datetsued�.G ,� f hw. Joaquin Local Health District for a permit to construct and install the work herein described. Application is hereby made to the San This application is made in compliance with County Ordinance No. 549. , 1- r- T"!"" -- --•--- --------- } -- JOB ADDRESS AND LOCATlO ------------------ ""- - one - P - ---- - ---- -------------- Owner s Name_ - --•----- Address Y --=---------- ------------------------------- if - -.-- --•---- _ W. - - ---------- ------------ Phone--------------- Contractor's Name------ --------- t Installation will serve: Residence Apartmen Ouse ❑ Com ercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units:~ J-- Number of bedrooms _I-- Number of baths __j---- Lot size _79-9-141i --------------------------------- 'to Water Supply: Public system Cammunijy system ❑ Private ❑ Depth to Water Table _7-10 I Gravel Sand Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan [] Character of soil to a deptk of 3 feet:# Sand ❑ ❑ y FHA/VA: Yes ❑ No Previous Application Made: Yes ❑i No [A New Construction: Yes � No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or!cesspool permitted if.public sewer is available within 200 feet.) ❑ „� Distance from foundation Material-----_--Septic Tank: Distance from nearest well---------------- ._Capacity___________________t9uid de th__ No.'of compartments--------------------------Size------•--------• Disposal Field: Distance from nearest well.--�7_I Distance from foundation__:_!2.4! ------Distance to nearest lot line--- P t Len th of each line----- ------------- Width of trench-___r r_ �------------------- Number of lines__________�_ -."- g Type of filter material______ __._ - ----Depth of filter material____ "��-------•--Total length___.__. ---•------"-- v - • -w� f Seepage Pi}; Distance to nearest well__�.+ �-�---Distance fronds ze nD;am�et�er"-"D'stance to nearest o me___ _______._._. Lining material Depth - D stance from.N6mber of nearestwell___=__-;__--____-Distance from foundation--------------------Lining mater"sal___-_..._.--------------------------. Cesspool: --Liquid Capacity .__.-__-__gals. ❑ ---- G P Y Size: Diameter-!------------------------- -------- ----DePth--------------------------------- Distance from nearest building------------------------------------------ Privy: Distance frorn`nearest well------------------------- - _ -------------------------- 'Distance ! - _- Distance to nearest lot line----`�------------=---------------------------------------- ------ (i' ---------------- Remodeling and/or repairing (dest1-ribe):___ _-._._-"-------- ------------- __"""___ ----- ------------- -: : - I hereby certify4hat I have prepared this application and than the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. orl ' ( 6 ' .. -----------------(Owner and/or Contract (Signed)----- --- ------- .1 -----------------------------------------------------(Title)-------- (Plot plan, showing size of lot, l°ca ion of system in relation to wells, buildings. etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY DATE----e------------------------------------------- APPLICATION ACCEPTED BY_ _�: DAT ------------ --------------------------- ---------------- --- -- REVIEWEDBY-------------------------------------------------- DATE - ---------------------------------------- BUILDING PERMIT ISSUED--------------------------------- \h Alterations and/or recommendations:__-__--_.___."____-------"-- - t -------------- y �� L- ' _-- ----------- _ - -Date_- FINAL INSPECTION BY:- _"" ---- ------------------------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 300 Wes+Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Lodi,tCalifornie Manteca, California Tracy. California Stockton, California • ES--9-2m , Revise6 1.57 f.P.CO. ,�+}