2550 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. «f__5___�^� _• _ ? ,r (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 N 549. ,, l ' JOB ADDRESS AND LOCATION ----------- --------- • `---------------------------/------------------ --------;t k Owner's Name --- Phone-- "- _ f Address----------------------------- ..r -- -D---------------- ---- - -- - A ------------------------------------------------------ Contractor's Name----------------------------------l �-l 41 --- --- dg� n Phone---•4=-4�7--44---a ' Installation will serve: Residence * Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ k Number of living units: __I___ Number of bedrooms -),--Number oLbgthhsl J-___ Lot size ___670__�X__l -_---_--- Water Supply: Public system Community system ❑ Private W Depth to Water Table _�10 ft- Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑, Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No K New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or.cesspool permitted if public sewer is available within 200 feet.) tic Tank: Distance from nearest well_-__,_______--_-Distance from foundation__________-_______-Material _____________________________________ No. of compartments-----------------------.__Size--------------------------------Liquid depth--------•-----------------Capacity---•------------------ Disposa! Field:l Distance from nearest well------------------Distance from foundation--------------------Distance to nearest lot line__________------- � �^" Number of lines-----------------------------------Length of each line----------------------------.Width of trench----•----------------------------- Type of filter material---------------�-�v_2&Pt ilf9r rpaterial-----------------------Total length-------------------------------------__--- Seepage Pit: Distance to nearest welL_G?_D-_--_--____Dist Dist-Ace from foundation___l�--_ Distance to nearest I� line____-_a" �_ 0 �� , k Number of pits------.�-------------Lining material�._(�Fr�'-_-5rze: Diameter___�_a'"�_--________.Depth_____-__©___�1�___ Cesspool: Distance from nearest well---------.-------Distance from foundation--------------------Lining material------------------------------------- El -______- ___---________-__❑ Size: Diameter--------------•-•---------------------Depth----------------------------------------------------Liquid Capacity-------------------------...gals. Privy: Distance from nearest well_____ -----------------------------------------Distance from nearest building-_-________.________-_--_-____________._. ❑ Distance to nearest.lot line- Remodeling and/or repairing (describe):____ F - %�� --------------•---------•--------------•----------•------------•--•------- ------------•----•-----------••------••---•--•--•. ••---••------•---•-----------=-------------•-••-----------•---------------------------------------------------------•-------------------------------------- hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Coun ordinances, State laws, and-rules and re ulations of the an Joaquin Local Health District. (Signed)--- - - '-�---- --`---- ---- - - -------�---�------- ---��------�------ - ----------------------------- -- --- -------- Contractor) B ). . / �. X14 Y� = ------------------------------------------------------- [Plot plan, showi g size of lot, location of syste in relation to wells, buildings, etc., can be placed on reverse side). E FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- - ------ DATE--- � __-J_ Y REVIEWED BY ------ - DATE BUILDINGPERMIT ISSUED-------------- - ------------------------------------------------------------------------------------ DATE Alterations and/or recommendation ---•----- - ' ----------- } ----------------------- --- ----------------------------------------------------- ---------- -------------------•----------------------------------------- FINAL INSPECTION BY-.-/ i�� Jx�'"°"------------------ Date •a SAN JOAQUIN LOCAL HEALTH DISTRICT "" "`` 130-South American Street_ 7�"' 300-West Oak Street W Sycamore Street 814 North "C" Street Stockt6Ei, California Lodi, California Manteca, California Tracy, California r - ES=q=zM-a-51 .Revised W-2100 _