6457 - Laserfiche WebLink

Home Browse Search

1� = APPLICATION FOR SANITATION PERMIT Permit No. ._jp. ,r . (Complete in Duplicate) 7/•� Date Issued -----_--S__�-_'I ___- 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 LOCATION----------- `' ------ �-0--- -�f_#/ --------------------------------------•----------------------------•--•-------------- Owner's Name-------1?a •--- �Y ` " rp t-L r�• ---------------------------------- -------------------------------------------- Phone------------------------------------ V -------------------------- ---- Address-------- 2( �� 1� '. L ••-----=-------------- -- # ---------------------------------------------------------------------------------- Contractor's Name--__. _____�,�,��Z�d�✓----------- ic_t-fir___.----------------- ----- -------------------------------------------- Phone----e!!*----('51G_v_Z._ r Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ -- JC /o°----------- Number of living units: __ ---- Number of bedrooms __ __ Number of baths --�_-__ Lot size _________ .______________-____ . , Water Supply: Public system ❑ Community system ❑ Private [Z Depth to Water Table-�--y- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ J -" Previous Application Made: Yes ❑ No [R New Construction: Yes ❑ No r TYPE OF INSTALLATION AND SPECIFICATIONS: ` (No septic tank or cesspool permitted if public sewer is available within 200 feet.) .yR Septic Tank: Distance from nearest well--_� __ Distance from foundation__._j�_______....Materia!______. _ p_____.h-"`---------------- �" 6 X JG-- ---- q p---- Distance---- --.-Capacity------5 cr_g-------- No. of compartments- __c�_-_----------Size------•--____-- _ Liquid derth__.__�-�-�_-. ` . Disposal Field: Distance from nearest well___J.Q_d�---Distance from foundation______14.. to nearest lost linet_:__�o------- Number ___Number of lines--------------/--------------._-Length of each line_______.__._-�_ _ Width of trench______-�_ ______.............. , ❑ e th of filter material----.-�...._ ---___..Total len th----------2n'--------------------------- � Type of filter materiaL_.e p -- g Seepage Pit: Distance to nearest well_ __./Z4).___ Distance from foundation--_.__ v_.___..Disfvice to nearest lot line_-__/C 1 -�---_ 7i -- -------.De ---------------- Depth 2 Number of pits_____....,__..__.__Lining material Diameter-__, _3 p Cesspool: Distance from nearest well----------------- from foundation-- -----------------Lining material__.._..-----_.._-._.____.._.-_-______. ❑ Size: Diameter------------------------------------.Depth-------------- ------------------- -----------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well __________________ -------.---------------------Distance from nearest building---------------------____________..____._. ❑ Distance to nearest lot line--- r- -------- ' ------ ---------------------------------------------------------------------------- Remodeling and/or repairing (describe)_________ _______________ - ----------------•- ------•-••-•------------•------- - ---• -- -----------------------•-----------------------------------------------------------• --------------------------------:.__.......-------------------------------------------------•------ -------------•-•• - ----------------------------•-----------------------------------------------------------------••------••---------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State S, and rules and regulations of the-San Joaquin Local Health District. [Signed) ` ------�- "- .' ner and/or Contractor) ' / BY: •' -- -�;7 fir"(- `1 [Title) - ----•-=•---- ---- ----------------' (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). F ' FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY----- --------------------- -- ---------------------------------------- DATE.-------�>----------------------------------------------- - ----- ---------- DATE----- �tF -----• -- REVI EWED BY-------------------------------- --- - - --- � ------- ------- ------------------------------- - ------ ---------•----- ------------------------------------ BUILDING -- - BUILDINGPERMIT ISSUED---------------------------- ---- ----------------------------------------- --------------------._ DATE--------- -- -------- v------------------------------- -- Alterations and/or recommendations:---------- ----- --- --- -----------------------------•------._...._..----•------------------------------.--•- ------- �---------•-------•--•----- J - t ------'-"-------------------------- ------------------------------- -------------..-_---.---._----------- ---------------------------------------------------------------------------------------------------••-•---------------------------•----------...---------------------------------------------......... .--•------------------------ ----------- -------------------------------------------------------- -- --------- ----------------------------------------------------------------------------------------------x _ 1 - -----------••--•-----_----••--- i. `--- -------- • ----------------- Date. ----- -------- - -------------------- FINAL INSPECTION BY:- - - -- `� ` A' SAN JOAQUIN LOCAL HEALTH DISTRICT ' 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, CaL'fornie,;.,,p., .r. Lodi, California: Manteca, California Tracy, California ES-9-2m 145446 ATWOOO 12-54