2875 - Laserfiche WebLink

Home Browse Search

Permi No. I f APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued Health District for a permit to construct and insta4l the work herein described. � I + Application is hereby made to,the San Joaquin Local He This`'application is made in compliance with County Ordinance No. 549. it e,, :. / 5__T------I-l-Al -------------- JOB ADDRESS ANP LOCATION---------- ---- -- _ --------------------- +�/"` __-- Phone__ _ ° Ow!I . Name.... + ��_ ------- 5 ----------------.----------------------------- �I -•---•--------•--------------•-------- Adldress--- ---- --•---------------------- _: -7----•- I ® �-------------- ----- Phone Contractor's Name____- - D �' �f Motel E] Other Elj Installation will serve: Residence K Apartment House ❑ Commercial ❑ Trailer Court [I , ___ Number of baths ---- Lot size _> �--�� °'�----- Number of living units: '1--___ Number of bedrooms _ _ Water Supply: Publics stem Community system ❑ Private ❑ Depth to Water Table �_ ft. \ i Y Clay Loam Clay ❑ Adobe Hardpan ❑ ChI Gravel Sand Loam ❑ Y ❑ aracter of soil to a depth of 3 feet: Sand ❑ ❑ Y Previous Application Made: Yes E] No V New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Distance from nearest we4l________________`Distance from foundation--------------_-----Material--____-__-_____-_-__-___-----_-- ------ Sepl. tic Tank: ---------------Li Liquid depth-------------------------Capacity----------------------- No. of compartments Size q � ❑ f f/ // ' Disposal Field: Distance from nearer well_��1��-..Distance from foundation__ __�- Distance to nearest lot line__-__el�___.__--------- are of trench_ ��y Length of each line ........... ch t �-- -- Number of lines___' - g Type of filter material _ -GK---Depth of filter materEal___ -------- -Total length__--_- . Q.•------- rom foundation____________________Distance to nearest lot line________.___.___. Seepage Pit: Distance to nearest well________________-__--Distance _--_ Number of pits----------------------Lining material-----------------------Size: Diameter----_------------------Depth----------------------- ❑ Distance from nearest well-----------------Distance from foundation-------------------.Lining material--------------------------------els. Cesspool: ' Size: Diameter----------------------------------- -DePth------------ ----------------------- ----- ------Liquid Capacity----------------- ------..._ 0 Distance from nearest building---------------------------------------- Distance from nearest well____________________________________ c A---------------------------------- ---- ❑ ----- --------------- " Distance to nearest lot line-------------- - e � s Remodeling and/or repairing (describe):___-:- -- ---------- h�'_... -----•---•-----------•-------•------- .i------------------------- ----------------------•--------------•-------•------------- -----------------------------...----•---•-------•----------------•----------------•------------------------------ - ----••-- ------ ----- IIII I hereby cerci hat I have prepare this application and that the work will be done in accordance with San Joaquin County ' dl k ordinances, Stat aw and ules and Peg ations@o# the an Joaquin Lac,a!"Health District. t�� d ) I1: ner nd dr Cont ctor ------ t (Signed)--------- � - -------------- - ---- ---r---- -----------(Title)---- -I- '�'.-!4� � ---- ----- ------ ------ -------------- By: ---- By:---•--------;.---Plot plan, showing sze of lot, location of system in-re lati to wells, buildings, etc., can be place on reverse side). . d FOR DEPARTMENT USE ONLY .APPLICATION ACCEPTED BY-- --- ---------------------------------------------------------------------- , DATE__-'-- ------ ----------------------------- REVIEWED BY-------------------------------- - DATE---___--- -- - --------------------------------------------------------------- BUILDING PERMIT ISSUED- ----- ---------------_ --- Alterations and/or recommendations:-_---------------- ---------------------------- ------------------.---------- 1 ---------- ----------------------------- r -- ----------------------------------------------- FINALINSPECTION BY.------------=------------------------- -------- SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street 130 South American Street 300 West Oak Street Lodi, California Manteca, California Tracy, California Stockton, California . 1 LS-9_2M 8-51 Revised W-2100 —M