7798 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. .--- -_ (Complete in Duplicate) Date Issued -----� o-_5 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 Ordinance No. 549. p,r_�Sa�� -- -,-._• - 111 JOB ADDRESS ANDD�'--}}LOCATION_ -''.--------Ci�+?/�� a a �C,, 1' 1 ►y/_.fit-- -+M -C��` `Pf / Owner's Name-------f7/`!- ' S YJ.r` ---------------------------- ------ -------- ----------------- - ----- ---- Phone----------------- Address--------------- 2 Contractor's Name.-.__ o.:--! - Y --,F-__T------- ----- ----. Phon - - ----g7P '�' Installation will serve: Residence ❑ Apartment House [commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___-----++Number of bedrooms -___--- Number of baths -------- Lof size _-��rz.i '---- ............__ ? Water Supply: Public system [-] Community system ❑ .�-Private /Depth to Water Table ft. 1. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [ ardpan [� Previous Application Made: Yes,�o ❑ New Construction: Yes ❑ No G' { TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Distance from nearest well-----------------Distance from foundation.-------------------Material _---._------.-------_.- No. of compartments------------- ------------Size--------------------------------Liquid depth--------------------------Capacity----------------------I Disposal Field: Distance from nearest well-/"--. Distance from found--a-tion-- s Number of lines------ Distance to nearest lot lin-y------ -- - geach -"---...Width of trench---ptType of filter ma#ara)- ---Depth of filter material- i .l -----A---_----- � ....--._Total length---�.__Q--!-_--___:--- Seepage Pit: Distance to nearest well---�.1D_(1-�-----Distance m f undation---. rr �i � .:� Di to ce to nearest lot lin -1 Number of pits----------r----------Lining material-_fs --_---Size: Diameter--- --------------Dept h..-!---------•-F Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_---.._----.-__--------.-------__- - w ❑ Size: Diameter------------------------------------ Depth-------------------- Liquid Capacity, gal- W Privy: Distance from nearest well-.__.-.-_- __ =--------------------_-Distance from nearest building---` ---------- Distance _--__Distance to nearest lot line- - ------------------------ Remodeling and/or repairing (describe)-------------------- ` -------•---• -----------------------------••---•----------------•----------•--------------------------- -------• --------•---------------------------•----------•----••------------ -------_------------------ I hereby certify that l have prepared this application and that the work will be done in accordance with San Joaquin County ordinances to laws, and rules nd regulations of the San Joaquin Local Health District. (Signed) ..... v T ----- ---- ---- --- --- ------ ;." Contractor) ------- . By:---------------------------------------------------------------------------------- Title a (Plot plan, showing size of lot, location of system in relation t wells, buildings, etc can be placed on reverse side). 4 _ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED ------------------ --------------- - DATE---- �-^�--• - - - ------------------------ VIEWED BY---------------------------------_- -------------------- DATE -..... BUILDING PERMIT ISSUED------------------------------------------------------- ----- DATE Alterations and/or recommendations:----------- ..... --------------•---------------------------------------------------------------.i"'-------------- . .------•------------------------•---.-__----__---.---_•-----__-...-_---.-_,-...-----__-_.-_--__-----..-------._-''---. ------------------------------------------------------------ ------------------------------------------------------------------------`------------- -- FINAL INSPECTION $Y:,/ - ! ---------__---------- Date--- SAN JOAQUIN LOCAL HEALTH DISTRICT 1 130 South Americen Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street I a Stockton, California Lodi, California Manteca, California - Tracy, California K551-5 146446 ATWOOO ,