8353 - Laserfiche WebLink

Home Browse Search

Permit No. _ APPLICATION FOR SANITATION PERMIT Q_. __.... (Complete in Duplicate) Date Issued Applica+ion 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 Ord-nance No. 549. JOB ADDRESS AND LOCATION ,- r- ---�------- - -� _.I�'�.� �. . . - --- -•-- ---•- - --• ----------- --- --- ---------•---•-------- - Owner's Name.... ° �J ° ''f ' Ph Address---------------- ----- ----------- ---------------------------------------- �---- ,e P----�----7/9------------------� --------------------•-----------------------------•----------------•------------------------ Contractor's Name-------------_------------- 16. .--------- ----- Phone. ------------- - ------------------------------------------------------------------ ---------- Installation will serve: Residence ApartmentpHouse [❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ` living of baths .-z--._ Lot size �. = ----- Water Somber Public system Community bedrooms __. Private Depth to Water Tabled:____ r Supply: Y ❑ Y Y ❑ �_ _ _ 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 /i,r„�,, Q✓ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) - Septic Tank: Distance from nearest well_________________Distance from foundation-------------------.Material-------------_--_--______.________-.-_________- ❑ No. of compartments------------�--]].----------.Size----- ---------------------------Liquid depth--------------------------Capacity----------------- ---=-- Dispo al�Z=— Distance from nearest w i{_40------Distance from foundati n___.___�...._._..Distance to nearest lot line---- Number of lines_____________ ...__r..__-_____ Lengfih of each line____/-O P_. .---- Width of trench......./�_ ----------------- Type or filter material__.,5.'f_ _Depth of filter materiaL1X_-;f ._--Total length---I_QQ______________________________ Seepage Pit: Distance to nearest well -_Distance from foundation_______________'__.Distance to nearest lot line.___.________.-_ ❑ Number of pits----------------------Lining material--•--------------------Size: Diameter-----------------------Dept h----------.--------------------_- 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------------------------------ ------------- --------------------------------- ----------------------------------------------- - Remodeling and/or repairing (descaribe):_d _r -f f ---• ! ... - - ------ ------ Is - ---------------------- -----------------------------------------------------•---------------------------------------------------•-----------•---------•---- ---------------------------••---------------------------- ---- --- I hereby certify that I have prepared this �'plication,a 1 that the work will be done in accordance with San Joaquin County t ordinances, Statea s, CIA ules and'reguiaffons/of the San Joaquin Local Health District. (Signed)-----------------•---- /-. -- --------- ------------------------------------------------------------(Owner and/.or Contractor) v By:--------------------- /---•---•......._._ .--------------------------------------------------------------------------------(Title)------------•------------------------------- - ----------------- (Plot plan, showing size o lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- ...,:----- ------------- ------- /?---�---J., �.. DATE----------------- REVIEWED BY---------------------- �'� -- ----- DATE------I f - ------ - -- - --- BUILDING PERMIT ISSUED----------------------------------------------------- v v--- --- -------- r ------------------------------------------------ DATE------ ------------------------------------------------..._._ Alterations and/or recommendations: -------------- --------- - -- ----- ---------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------ - ------- -------------------------------------------------------------------------------------------•--------•---------------------- ------- --------------------------------------- --- ------------ ---------------- ------ - -------- ---------- FINAL INSPECTION BY:... . . --------------------------------- Date------------------ .-- ------- 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 i - E5-9-2M 146446 ATWOOD 1254