8664 - Laserfiche WebLink

Home Browse Search

t APPLICATION, FOR-SANITATION PERMIT, ' Permit No. G.6_�- (Complete in Duplicate) 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 application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LO ATI N_________ U- -_- Owner's Name----------6 6----�t--------- -- --- -----•• --------------------------- ------- ------------------- -------- Phone--------- ----------•---••---------- Address---z--------------- Contractor's Name !_ ----------• -------- Pho,%/of-�f -1,_4�. , - Installation will serve: Residence E4]--A�partment House ❑ Commercial ❑ Trailer Court (] Motel ❑ Other ❑ Number of living units: /___ Number of bedrooms _PZ- Number of baths __L Lot size --- 5_-7,5-'.�______________________._ _ Water Supply: Public system 54_�ommunity system ❑ Private 0 Depth to Water Table So ft. Character of soil fo a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [] Clay Loam [] Clay El Adobe g?"Hardpan ❑ e Previous Applicafion Made: Yes ❑ No E4---New Construction: Yes ❑ No [ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: r; (No septic tank or'cesspool permitted if public.sewer is available within 200 feet.) tic T nk:, Distance from nearest well-----------------Distance from foundation--------------------Material---------- _---_----- No. of compartments------------- -----------Size----------------------------:---Liquid depth--------------------------Capacity-----------•----------- i oral Distance from nearest well _______________Distance from foundation--------------------Distance to nearest lot line....._--___-_-__- Number of lines-----------------------------------Length of each line------------------------------Width of french Type of filter material------------------------Depth of filter material-----------------------Total length---------------------------,------------- / I Seepage Pit: "Distance to nearest well _ _ Distance— om oundation__-pZ.�---____.Distance to nearest lot line_��__.___-_ �f Number of, its_--_ ._ / '� p' l_______-- _Lining material___ _D. .______Size: Diameter__ rj_______..Depth____ -S'_________________ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------_-_____.__-.-,-_.---____--_•_. ❑ Size: Diameter-------------------------------------Depth_--------------------------------------------------Li Liquid Ca acit q p Y ----------------- •-------gals. Privy: Distance from nearest well------------ _--------------------------------_.-Distance from nearest building------------------------------------------ Distance ----- ---___ (� ❑ Distance to nearest lot fine----=------------= = Remodeling and/or repairing (describe)=----------------------------•------------------------------------------------ ---------------- -------------- ----------•-•--------------•-------------------------------------------------------------------------------------------------------------------------•--------- --------------•-------•---------•---------••- -•-------•-- ------.,_..------------------ ---------------- ---- i. I hereby certify that I have prepared this application and that fhe work will be done in accordance with San Joaquin County ordinances, State-laws, and rules and regulations of the San Joaquin Local Health District. \ (Signed)-------- - - -------------------- (Owner and/or Contractor) BY= ---------------------------1?e (Title.........�-�---- (Plot plan, showing size of lot, location of system in relation to wells, uildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY--------------------------- ---- - --------------------------------------------------------- DATE------ REVIEWEDBY ----------------------------- --------------- --- --- ---------'-----------------------------------------------.. DATE-------- BUILDING PERMIT ISSUED------------------------------ = - DATE. - � R Alterations and/or recommend ations:---------- --------------- ------------------------ X. .___.,__-_ __________________________•-..--___-_ - ! --- ----------- -- ---------------------------------------------------- -----------------------------------------------------.----------.. ---------------- ------•--••-------•-••---•--- ----------------- ----------------------- FINAL INSPECTION BY:----- - Date w SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Sfreet 814 North "C" Street Sfock+on, California Lodi, California Manteca, California Tracy, California ES-9---2M Revised ;-$7 F.P.CO.