4898 - Laserfiche WebLink

Home Browse Search

1�1e , APPLICATION FOR SANITATION PERMIT r_ Permit No. .._ .� , (Complete in Duplicate' u �], v Date Issued 0e1 f Applical-ion is hereby made to the San Joaquin Local Health District for a permit to construe0. d install the work herein described. This application is made in compliance with�County Ordinance No. 549, 5 JOB ADDRESS AND LOCATION ______ 7_ ______ rd.-._-----__•_ � t -------------------------------------------- ------------- - Owner's Name ++� --- -- ------- o c --------•----------------- -------------- Phone- Address--••;F-!-1°2 ------ � '' ----------------------------------------------------------------------------------------------------------------- Contractor's Name-------- -----__-_____--_____ -*-_ -- L� ----------.�� ------ ----- -------------------- ------------------------------------------ Phone-------•-Q�.�;•�----- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -_ ____ Number of bedrooms ___ __- Number of baths - _..-_ Ldt size __.____ --- - ----------------•- Water Supply: Public system T--l"Community system ❑ Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand Gravel E] Sandy Loam E] Clay Loam ❑ Clay E] Adobe[f�Hardpan [3Previous Application Made: Y6s E] No New Construction: Yes No �] i TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tank or cesspool permitted if ublic sewer is available within 200 feet.) Septic >4 Distance from nearest well- _ fih Dista_cQ�froM foundation---J ----.__.Mater No. of compartments}-------c2-------.---__Sizels_�_ Q_�C_S Liquid depth_-----4/Z__i_--Capacity_._ Oa - �^y� � - Disposal field: Distance from nearest well-/ Y�-r✓Distance from foundation____ d_--.._.Distance to nearest lot line__Z ____ F Number of lines_____-_---1_-----..__`'-,�-(__Length of each line__-_- -- -------_-_____.Width of trench------. _ '� Type of filter maferial_S/�Y�___Depth of filter material----I-?--i--.---Total length---------Z$---i--------------------- p 9S --_Distance to nearest lot line See a e tt: Distance to nearest-well-.__Dist e rom foundat n_ ----- Number of pits.-----�-----------Lining m eriaL -Size: ameter------W I-(---_Depth....-51---------------- Cesspool: Distance from nearest well__-_______ __.__ istance from ion....................Lining material-------.__________-___.________ ❑ Size: Diameter-----------+ _---- ---- - - ----Depth-------------------------- --- ---------------------Liquid Capacity----------------------------gals. O Privy: Distance from nearest well -------------------------------------------Dis#ance from nearest building------------- ____------_--.-_-----------. ❑ Distance to nearest lot line- ----------------------------------- -------------------xF' ---------------------------------------------------- -------------- a Remodeling and/or repairing (describe):____--...............:___.__-----------------------------= -------------- ---__.i s r -- , _ --------------- k O ______________________________________________________________________ __________________________________________ _____________________ _ _ _____________________________ _. ------------------------_______________________________________________________________________________________________________________________T_.__.__-__---.--_---__._.---____--____--.___--_-___-___--_-___._-_----_.____ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State I ws, and rules and regulations of the San Joaquin Local Health District. (Signed) -- - .................. (O er and/or Contractor) v4— By--------------- ----------------------------------------------------- (Plot ---------------------------------------------(Plot plan, showing size of to , location of tem in relation to wells,'buildings, etc., can be placed on reverse side. } FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY + f ------ DATE- l REVIEWED BY----------------------------- DATE BUILDING PERMIT ISSUED------------------------- •------ -- -------------------------------- -------------------------------- DATE_.- Alterations and/or recommendations:--------- ---=--------------- -----------------------•----------------------------------------••-------------------•-------•----------- ------------------------------------ FINAL INSPECTION BY:------------------------ -----_.- 7 %4--%A ------- Date-----------V-----/---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Soufh American Street 300 Wesf Oak Streef 132 Sycamore Street 814 North "C" Street Sfockfon, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised W-2100