68-331 - Laserfiche WebLink

Home Browse Search

1�1_ - ' FOR OFFICE USE: - I ° .. ' ------ --------- .___ -------- - APPLICATION FOR SANITATION PERMIT Permit No. _f� ~_3 / ----- -- --------- IM (Complete-in Duplicate) This Permit Ex ires 1 Year From Date Issued Date Issued �• Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This applicati'n, is made in compliance with County Ordinance No. S49./� f JOB ADDRESS AND LOCATION._____._ _- � / - I/�/ ----------- �" /" "- D%Zl -- i } Owner's Name--____-• e_ -- ��Q� -- -�-4--•�, Phone---- Address--------• = ,_.� J � 'X"��7G _. r? - A ------------- --------------------- ----------------------------- Contractor's Dame -•------•- /a` --------------- ------- -- --- Phone------ ............................. Installation will`ilserve: Residence Q partment House ❑ Commercial ❑ Trailer Court [] Motel ❑ Other Motel Nurnbelil'of living units: _fNumber of bedrooms __-& Number of baths._ -- Lot size _..�! Water Supply _ _/-. '�-e ------------- ------ : Public system ❑ Community system E] Private �epth to Water Tablee? ft Character of s it to a depth of 3 feet- Sandgavel ❑ Sandy Loam 0 Clay Loam ❑ Clay ❑ Adobe Hardpan Previous Appli anon Made: (!f yes date_______ __ _______ ) No ❑ New Construction: Yes �lo El FHA/VA: Yes � No El OF INS�ALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se tic Tank: -� - p� Distance from nearest well .-----_-Distance from fou dation_. .11__�_.___-- M �na;.._ -� ------------ &A __4 --- No. of compartments_ _Size Liquid depth._.. _ --. .----_-.Capacity., ___-- + Disposal Field:. I Distance from nearest IF----Distance from foundati n_____, _�_ -pistance to nearest lot line___- _.__ F E Number of lines __.____._ Length of each line__ . ___ ._ '� i 1 ��----------- ----Width of trench__.Q7_� -, _ Type of filter material._.-.f/�&% 6epfh of filter material-If---f-.-.---Total length---- . Seepage Pit: Distance to nearest well______________________Distance from foundation-------------------Distance to nearest lot line__.__...______.., ❑ I I Number of pits--- ----------- ------Lining material--------- ----------- Size: Diameter---------------- -.---Depth---------- ---------------------- Cesspool: I Distance from nearest well ________________Distance from foundation._ __----------- Lining material_-.._____._-_----___ ❑ Size: Diameter. ._ ----------------- i ---- --- ...Depth- ------------- ------ ---- -- ------.Liquid Capacity. ------------- ------------gals. Privy: Distance from nearest well_._------------------------------ ---------------Distance from nearest building ❑ I Distance to nearest lot Gne Remodeling and/or repairing (describe):----- ----------------------- t/'� X11, --� --------------------- ---------------------------- ------------- ------- --------- --- ------------------------- ----- ---------------------- ------------------- -------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------ --- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, nd ales and lat, ns of the San Joaquin Local Health District. i�� (Signed)------------- ------ ' - - (Owner and/o o t ` SY� '----•- n rac or m lC -.CAlJ. (Plot plan, showin e.-of lot,-location of systemin relation to wells, buildings,setc-rcan-be-be-plated on-reverse side). II: g P . _. ... FOR DEPARTMENT USE ONLY APPLICATION (ACCEPTED BY_ ------------------------------------------------- --- - - - - ----- -- ---------- DATE---- ------------------- - --- ----------------- REVIEWED BY-=�l------------ --------- - ----- ._ DATE BUILDING PERMIT ISSUED-------- -- - ------ ------------- _ DATE Alterations and/or recommendations _ ----------- ------------ ------------ --------- -------------------------------------------- --- ----------- - ----- ---- ----------- --------------- ------ -------------------------------------- ------------------------ ----------------------------- ----- ------- ------------------------------ ------------------------------------------ -- ------ FINAL (NSPEC ON B i � ---- ----- bate------------ ' SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E. axellon Ave, 300 West Oak Street 124 Sycamore Street Ali 20.5 West 9th Street $ock}on,California Lodi, California EM,9 2M 1-67 VangManteca,California Tracy, California uard Press