8584 - Laserfiche WebLink

Home Browse Search

f APPLICATION FOR SANITATION PERMIT Permit No. $ --✓/...f...... (Complete in Duplicate) Date Issued -.3-C 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 Ordina No. 549 JOB ADDRESS AND LOCATION/fif y Owner's Name- ... i4l- =< ------------------------------------------------- < ph------ ------------------------------- `------------••------- one----------- Address----- ----- - - -- -•-•--- - ------•-------------------••- ---------- --------------------------------------------- Contractor's Name- ----------•--. Phone-------------- Installation will serve: Residence @jam Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ "i Number of living units: Z Number of bedrooms -A_ Number of baths - -.- Lot size ---_- -------------- Water Supply: Public system Community system ❑ Private p Depth to Water Table'K�7ft 1 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe fardpa ❑ Previous Application Made: Yes ❑ No &--"New Construction: Yes ❑ No Z;J.- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sept ,Tank: Distance from nearest well----------------•Distance from foundation_._--_--.._.---,__- Ma+e�ial--.__--.____--__.--_,_---____ No. of compartments -Size--------------------------------Liquid depth--------- ....... Capacity--------- -, i �Ftelcl, Distance from nearest well-----------------Distance from foundation---------------------Distance to nearest lot line Number of lines---•-------------------------------Length of each line------------------------------Width of trench.--------- Type of filter material-------------------------Depth of filter material-------------- -----Total length----------- ----------- ,------------_ Seepage Pit: Distance to nearest well._ ize: Diameter s 4`�,s ~J -- Dept --------- - Distance rom ound ion--_ _-----_..-- D' t ce to nearest lot ne Number of pits Lining material eter ----- Cesspool: Distance from nearest well ❑ Size: Diameter -:--_-----_.-._-Distance from. foundation-----.--------------Lining materiaL,"-__--_- --- - - ------------- ------Depth--------------- --------------------------- --------Liquid Capacity gals. x_� Privy:. Distance from nearest well ------------------------------------------------Distance from nearest building-__-..___--__---__ El Distance to nearest lot fine-____------__---..____ .`�.. , --- Remodeling and/or repairing (describe):--- ------ - . __- !R _ I ----------- ---- ----------------------------------------------- --------------------•-----------••--•-----------•-----------•---------------••--------------------------•--------------------------------------••------ ---------•----------- V - -------------•-•-------------------------------------------•-------------- -------------------------•--------------••--------------------•----------- ---------- 1 hereby certify that] have prepared this application and that the work will be done in accordance with San Joaquin County_ ordinances, State laws, and rules and regulations the San Joaqui ocai Health District, - (Signed)---------------- -�•�L•�--�- - --- - ------- ---- By:._.. --------------------- x� -I +le) / J r Contractor) ------- „ (Plot plan, showing size of lot, ation of system in relation to wells, buildings, etc., can be placed on revers ide). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------_- ------------- DATE---- -REV ----------- IEWED BY ------------------------ -------------------- - ------ -- - -- DATE BUILDING PERMIT ISSUED. --------------------- - -- --- -----•-------------------------------------- Altera+io and, r recomm ndatiops ------------------------ ----- DATE---------_--_ _ --------------------------- -- - -•-- . -----•- •-----•--- •---- FINAL INSPECTIONBY:----- S s Date-. r SAN JOAQUIN LOCAL-HEALTH DISTRICT K k 130 South American Street 300 West Oak Street 132 Sycamore Street 014 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-V 145446 ATWOOD