6508 - Laserfiche WebLink

Home Browse Search

� 1% APPLICATION FOR SANITATION PERMIT Permit No. _ -_---•____ i (Complete in Duplicate) Date Issued 1- l__•- S�� Applica-lion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS .AND LOCTION... -._3 4-------_ ✓ - //�� -------------•----------- ---------------------- Owner's Name -------- -� rr .�„� - -- - ,:------ -��m�Ea--------- --------- -------------- Phone.-------------------•--------- Address__.- �� ---- Gontractor's Name_. [� ----- ----'--'-C, '---- - ------ Phone_ _ __..S_ _�Z___�a Installation will"serve: Residence Apartment House Commercidl ❑ Trailer Court ❑ Motel ❑ Other ❑ � Number of living units: ___ Number of bedrooms c�-_ Number of baths . _ Lot size __ (1--� � -------------------- Wafer Supply: Public system Community system ❑ Private ❑ Depth to Water Table ' s Character ff- of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No ;i�f New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS:- f ) (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ` Septic Tank: Distance from nearest welle& _ _-_Distance from,foundation--,-' -__-__.Material__ . _._ No. of compartments �• P �_..-..- ---.Size__5 size--"-, dap+h._� -- �t_.Gr/ ��------------Capacity._gSd_- ----- I 3 -s Disposal 1=field: Distance from nearest well�d-��pistance from founda+ion__vZQ_��--___-Distance to nearest lot line___________ VNumber of lines------- -----Length of each line7,Sf�---__ W/idth of trench--.� � Type of filter material- _.- . tLinin ' 11f i er ma I_. Total length-__-_-__9�--------------- Seepage Pit: Distance to nearest welt__ tance-from fqun atio ___ � S _____.Distance to nearest lot line-___----____-__ Number of pits--_.�-------------- riala!iCt > '� De th_-.ize Diameter_-___Cesspool: Distance from nearest well__ fancefrom fou ation-.____------i__----,Lining material_.-.-_- ---------------------------- ❑ Size: Diameter-- - --------- - --- - Li uid Ca acit ----------------------------gals. Privy: Distance from nearest well------------------ �} -------------------------Distance from nearest building------------------------ i El Distance to nearest lot line_________________________ ---•---------------- --------------------- Remodeling and/or repairing (describe):___--.----_-------------------------------- --------------------------------------- ---- - I ----------------------------------------------------•------------------------ ication and that the work will done in accordance with San Joaquin C I hereby certify that 1 have prepared this applbe { ordinances, State laws, and rules and regulations o�fs the San Joaquin Local Health District. (Signed)------ D 4 ------------------------------------ - --------- -(Own" -d/or Contras r) BY: fC� C ,1lc •� -- -- ---------------------- (Plot plan. showing size of lot, location of syst jjn relation to wells, buildings, etc., can be placed on reverse side). .J FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY_�'._------------------------------------------------------------------------------ --------------------------•------------- DATE-- REVIEWED .BY ----- --------------------- -- ---------------- ----------------------- DATE___0%., ----------------------------------------------- ------------BUILDING PERMIT ISSUED----------------------- -- -- ----•------- ------- DATE---- Alterations and/or recommendations----------------------- �" � --------------------------------------------------------- ------------------------------------------------------ --- FINAL INSPECTION BY---------------------- — -- Date--- SAN JOAQUIN LOCAL HEALTH DISTRICTt 130 Soufh American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Sfreef Sfockfon, California Lodi, California Manteca, California Tracy, California ES-'4-2M 145446 ATW09D 12-54