8059 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. -- ---- (Complete in Duplicate) Date Issued ---------------------- R I I Y 4- ' Application is hereby mad to the San Joaquin Local Health District for a permit to construct and install the work herein lesc abed. This application is made in. compliance with County Ordinance No. 549. _�.,�_ �,��rr• / j ' it --- ./-- JOB ADDRESS AND L CATION__��_,L___.�__._-__-_-_ �.Owner's Name ✓ ?,�a�. .- ---------------------------=- --- --------------------- ------------------ Phone-------------------- Address----------------- � L •, �eC.... �u e7 -� Contractor's Name-------------PP--------------------------------------------------- ------- --------- -------------------------•---- --------•-------- Phone----------------------------------- r Installation will serve: Residence ® Apartment House E] ' Commercial [:] Trailer Court C] Motel E] Other ❑ N�' C r e Number of living units: ..�____ Number of bedrooms .-_ __._ Number of baths -__.____ Lot.size .-r�7_- -X__-�. _Q-------------------------- ijl Water Supply: Public system El system ❑ Private Depth to Water Table __. ft. ql� Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑' Clay ❑ Adobe❑ Hardpan El Previous Application Made Yes [-] No E] New Construction: Yes [❑ No �A?I r i+�rr�# } TYPE OF INSTALLATION,AND SPECIFICATIONS: � -�+"'"�+(No-septic tan k=or cesspool=permitted-if-public-sewer-is-available within 200 feet.) Septic Tank:` Distale from nearest well-340 _.---Distance fro'm1 fo nda ------------------- al__ ----------------- No. o f'compartments_--..-.L----------------Size_/D�_T- - -.3,Uiquid depth------,3----------------Capacity--- d� Disposal Field: Distance from nearest we€_5ZQ/-----_Distance from foundationjr_2rr3_-�..�.Pistance to nearest lot line__ Numb�`�r of knes------3-----------_ of of each line__ 9�_sJd� -_-.Width of trench_-_- . -_----------------------- Type oT filter material._S,_�{,/&epth of filter material.__... .._------Total length---f.�Q_'-_______________________ Seepage Pit: DistaJe to nearest well ---------Distance from foundation__------------------Distance to nearest lot line.________________ ❑ Number of pits----------------------Lining material----------------------.Size: Diameter------------------.----Depth---------------------------------- Cesspool: Distal e from nearest well------------------Distance from foundation-------.-------.-__ Lining material_.---- -__-----.-------_--_-________- ❑ Size: Diameter------------- -- ------Depth--.------------------------ ------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well __..--_____________----------------------------Distance from nearest building------------------------------------------- F ❑ Distance to nearest lot line___------------------- ----------------------------------------------- f IRemodeling and/or repai�`ing (describe)----------------- ----- -----•- ------ ---------••-•-•---•------------••----•----------------------------------------------------------------------- ------•----------------------•--------•-----44----------•------•-------------------------------------------•---•-----------------------------------•--•-----•------•---------------------------------------------- --------------------------------------------t--------------------------------••------------------------------------------------•-------•-------------------------------------------------------•---------------------------- t. I hereby certify that:I have prepared this application and that the work will-be done in accordance with San Joaquin County ordinances, Sf a laws, aril rules and regulations of the San Joaquin Local Health District. '-:---_ �-_ [Owner and/or Contractor) ---; ----- -- ---- --- --- ---------------------------------------------------- (Signed) �- -- --:- ------------------------- _- (Plot plan, showing size of lot, location of system in rela on to wells, buildings, etc., can be placed on reverse side). FO PART ENT U E ONLY F s APPLICATION ACCEPTED BY____ _._ __..R. - _�_- -- .re-x �.�- DATE__._ _____ REVIEWED BY ------ DATE--.-/-------------- - ----------! ----------------------- ------- BUILDING PERMIT ISSUED---------------------------------------------- ------ DATE------------------------------- ---- ----------------------- Alterations and/or recommendations M :-----------•-- ------ ------ -------------------•-•--------------------------•---• -•----------•-----------------------------••-•--------•----•--•----------- ------------------------------- -------- ------ ----------------- ------ ------------------------------------------ ----•---••---._-.---••--•----------------••----------•------------ . ------- --------------------- -- -IM.- . • -- ------------- ------------------------------- - --------------------------------------------------------------- --------------------------------------------------- ----------------------------------- - ------------------------- ------------------------------------•------------------------------------------------------------------------- - \ ---------------- ------- -------- - ---------------------------------- ---------------•-------------------------------------------------------- ----..-..--------•-------------•-------------------- f FINAL INSPECTION J:----------- f ------ Date.:--- � l ----------------------------------• ___- . - 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 at i /E 5--9-2M 145446 ATWOOa I2II-54