7018 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. ........ . .... (Complete in Duplicate) /Vx- Applica4ion Date Issued ___-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 Ordirlapce No. 549, JOB ADDRESS AND LO TION it ";---' Owner's Name_----- � ��` `" - ... Phone ................------:- ----------------I----a--m-ey--- ----------------------------7-- 1 Address---�{tQ 1 a ...... --------•- • •--- ----------------------------------------- lel Contractor's Name �C� -•-- -- --------•-----------------------------------------•-------•------•---••----•--- Phone----••-----••-----------•---------- a Installation will serve: Residence ] §,artment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ _____\Number of bedrooms 'Number of baths .-�___ Lot size ____.__-�--- -_________________ 14 Water Supply. Public system ❑ Community system ❑ Private 1"1 Depth,to Water Table ______- ft. 4. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy loam ❑. Clay E66m ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ N/9 New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No sgptic t'k or cesspool permitted if public sewer is available within 200 feet.) Septic Tank:' ante from nearest well_________________Distance from foundation-------------------Material___________.__-_____----------------._______- r . of compartments---- ---- --- ----- -----Size...._..-- •--•------------.-_Liquid depth--—------------------------Capacity----------------------- Disposal ield: tante from nearest well__._.-7C5----Distance from-'foundation___ ee 1J.�-_._-.Distance to nearest lot lin!/_�'7`__. p Number of lines____________..___..- Length of each s line_____&_(?__ Wdth„of trench_..-Z,!i!5 _________________ Type ..{{ Depth of filter material..�,�_ __ al length___.___- T e or filter material._.;.1__- &0---__--____ � r ge Pit: Distance to nearest well______________________Distance from foundation________________....Distance to nearest lot line----------------- � aA ❑ Number of pits----------------------Lining material----------------------Size: Diameter----------7-----------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance 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):-------- ._ _-_ __.it-.- --------------- --------------------------------------•----------------•-------••--------•-------------•----------------- -------•-------------------------------- ----•--------------------•-----------------------•-------- -- ` -------------------------------••----------•---•----_-----•-------------•-------------------- --•----------------------------•---•----•----------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done.in accordance with San Joaquin County ordinances, Sta�t'e)laws, and rules and regulations of the San Joaquin Local Health District.` (Signed]---fit /�,/c -------------------------------------------------------------------------------------•--------------(Owner and/or Contractor) r - - By:------------------------------------------------------------------------------------------------------------------------------------(Title)---------------- ----------------------------------------------- (Plot plan;sheaving size of lot;location of system in relation to wells; buildings, etc., can ba placed on reverse side). ! FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----•---- - --------------- ----------- ------------------ ----------------___-----------------.'- DATE------------------------------------------------------------ REVIEWED BY--------------- --------------------------- DATE-----= y r'� ------ BUILDING PERMIT ISSUED----------------------------------- ---- ---- -- . "DATE--=------�-��------�. �_. �----•...__.. -- - - ------------------------- Alterations and/or recommendations:------------------ _---------------------------------------------------------------------------------------------- _} ------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------- 1 -----•------------------------------ -------------------------------------------------------------------------- •---------=-------------------------------------------------------•--...--- r FINAL INSPECTION BY______________ - Date-----_----- (^. 5� _ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 014 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 145446 ATWOOD 12-59