9926 - Laserfiche WebLink

Home Browse Search

Permit No. ..�-�-='Z-�•- APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued ----17v/•-,•- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work her described. �� This application is made in.compliance with County Ordinance No. 549. . �— G JOB ADDRESS AND LOCATI N.______jlvtil!�---71 i :'' "" ' C� - Phone--- ---------------- Name ----------- Owner's ------ " ------- ----------------------- ----- Address --------- ---- --- --- �. �_ - ---------------------------------•------ Phone--------------------------••------- � Contractor's Name--- ---••----•--e------------_--------------------------------- �.' Motel Other ❑,, Installation will serve: 'Residence � :, Apartment House ❑ Commercial ❑ Trailer Court ❑ ❑. 7 ,• '� Lot size - 0 h Number of living units: __ ____ Number of bedrooms ____Number of baths __�- y+� e Community s sfem ❑ Private Depth to.Water Table Ir- ft. Water Supply: Public system ❑ Y Y - Character of soil to a depth of 3 feet: : Sand ❑ Gravel ❑ . Sandy Loam Clay:FHA/VA: am ❑ Clay ❑ Adobe❑ Hardpan ❑ No jr Yes ❑- No ❑Previous Application Made: .Yes ❑ No �ew Construction: Yes ❑ « ,- ,r. -� s TYPE OF INSTALLATION AND SPECIFICATIONS: ' k t . I (No septic tank or`cesspool permitted if pu645 server is available within 200 feet r �. Distan e-from {6yation-- _--_----:------.Ma 4_:_-- Septic Tank: -Distance from nearest well:=-14- ► Liquid deptii------- --a-------------Capacity--- Na. of compartments_____---- Size__ - } -- Distance to nearest lot lige distance from foundafion__�_____________ � . Disposal Field: Distance from nearest well__ -- --- �Len th of each line__-_____._,-[-4-__--_ Width of trench___'-. - ---- m Number of Tines------- g f �r?v► p� .Depth of'filter material------- - ----------Total length of filter material_:-7g.- - Seepage Pit: Distance to nearest vi-ell-------- from foundation----------------'...Distance to nearest lot lin e__,__.-__________ f Number of pits------'---------------Lining material---------_------ -----Size: Diameter__._.------------------Depth---------.---------- Cess❑pooi: Distance fiom. nearer# well___:---,'-------Distance from foundation____--_- Lining material________________________-_--__------. ❑ Size: Diameter-------------- -------° .;-- - Depth = -----=----------------------------------Liquid Capacity ga Privy: Distance from nearest well-------------------------- - Distance from nearest building------------------------------------------ W ❑ Distance to nearest lot line-':------, _------ ------ -------- ------- --------------------------------------------------------------- r ------------------1-----4 ________________________________________________________________________ Remodeling and/or repairing (describe):--------------------------------- ---•--:---�' --------•-•--------------- ! hereby certify that I have prepai-ed this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and r, lt'sfand re ulations of the an Joa �n Local Health District. ------------------(Owner and/or Contractor] ned -- ------ _ -------- (Sig )= 1. ! t (Title)--------------------------------------------------------------- ---- ------------------- -- --- 6uildin s, etc., can 6e.,placed von-reverse side). ,_ _ - (Plot plan, showing ' e of lot'�loca4ion of system i relation to wells, g :..• 1= E R E 5E O N APPLICATION ACCEPTED BY------- ----- ----- - --`---- ------ -- ' DATE----- --- --- - --- -----ZI REVIEWED BY----------------------------- ------------ - ------------------=----------------- RATE BUILDING PERMIT ISSUED-- - -: - ---- ----------- ------.: DATE------------------------------------------- •--------------------- Alterations-and/,or recommendations:-____—_-- -` ------------ .-- i -. _ ------ -------- -----••------------------- -- - ----•-------- ------------------------------------------- _ e.. f -- -- -. _ .... Date----- ---- - ---- -------------------------------•---- FINAL INSPECTION BY:_--- SAN JOAQUIN LOCAL HEALTH DISTRICT 1 814 North "C" Street 300 West Oak Street 132 Sycamore Street - 130 South American Street Tracy, California Stockton, California Lodi, California Manteea, California Y' E5-9--2M Revises 1.57 F.P.CO. y