7120 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permi7.1--—-----;:- (I/ (Complete in Duplicate) r Date Issued 1 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 C ON---- ---- --- ----------o-- -------- -----------L✓ i -------------•---------------------- Owner's Name--- --,-p-------------- -- -- ----------------- ---- ------------------------------------- Phone------------------------------------ Address._. �.. �- 1 - ---- •-- -----------------•..............-----------------------------------------------------••----------•------------------------- Contractor's Name--- -- --- --------- ----------------- C '`"= Phone------------------------------------ Installation =Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court (] Motel ❑ Other ry❑ Number of living units: .__-._'- Number of bedrooms _.Number of baths T"---- Lot size __ 'Y -- -Cl--------------------- t Water Supply: Public system W Community system ❑. Private ❑ Depth to Water Table .d!a ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel [] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No� \ TYPE OF INSTALLATION AND SPECIFICATIONS: ` { (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: 'nearest w•eIL_��-Distance from foundation---/0-----------Material.�jf,._e__ ----------- Distance o. of compartments-._-___ Size-- R_}C ---Liquid depth------ rJ.____------Capacity_.-- ___-- Disposal Field: Distance from nearest well__ 7-14)istance from foundation Id.r---.-.Distance to nearest lot line---_---- ptNumber of lines----------- /.----------- Leuzith of each line-------- ._,_-:Width of trench.._.x._54------------------- 4 Type of filter material--______ _ _ ----5'lith of fiJ.ter-rt�a#e�i I-. - g __._.Total length........ , ------------------------ fro _________ ___ Seepage Pit: Distance to nearest well__. -. :-i�'NJ�istarfce from foundation_-_re� ..4-__pistanc�eo nearest lot line---- �.�.-. Number of pits__._______._____-Lining rna ri _- ameter____. ,r�>..-- -Depth----- ---------- ia�atn�,� 'o Cesspool: e tn__--- Cesspool: Distance from nearest well__..----_----.-- a ion--------------------Lining material--.___-----------------------__--__.. ❑ Size: Diameter--------------------------------------Depth---------------------------- --------------------!�-Liquid Capacity----------------------------gals, Distance Privy:❑ Distance to e'nearest well------------------------------------------------- _ .. ------.-Distance from nearest building.-____ ------._-_--____ ---_----.--_---. , crestlot line--------- -------------------------------------- ---------------------------------------------------•---------------- ---------------- ii Remodeling and/or repairing (describe}---------- -----------------------°--------------------------------------•--..--------------------------•---•-------------------------------------- :F ---------------------- ----- ----- --------------------------------------------••------•----------•-----------------------•--------------------------------------------•-------------------- I hereby ce at I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St a laws and rules,and regulations of the San Joaquin Local Health District. (Si ned -._ g - {Ower and/or Contractor) ty BY:-- --- ---- - - -----------------------(Title)--- ------~-----• •---------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY. �` ----- -------------------------------------------------------- DATE---`.-.-._.- - - REVIEWEDBY---------------------------------- ------------- ------ --------------------------------------------------------------• DATE---------- ------ BUILDING PERMIT ISSUED---------------------- ---------- ----------- DATE-------------_---------- Alterafions and/or recommendations:.._-___----. -- -- ._ ..-•---•---------------------------- -- -------------- - ------•---- 5 ---------o------------------- -----•---- •----- - • -------- - ------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------•----- r FINAL INSPECTION BY:, r _3 - ------------------- ---------- Date........ ---`--�� Q-----'- ------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C Street Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2M 145446 ATWOOD 12-54