8542 - Laserfiche WebLink

Home Browse Search

'+ II APPLICATION FOR SANITATION PERMIT Permit No. ._-.U_.S. z` (Complete in Duplicate) Date issued ____ Applicaa-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 co p ante with County Ordinance No. 549, , s �- " JOB ADDRESS AND LOCATION---------------- ---- --------------'''r - E �-�-----"'. � �-_•--r-------------------- Owner's Name.------- �. � 14 _x'. ,--- ----- -- -- Phone--------------------------------- --- � ----------• ----------------------------------------------- Address-------•f = * l Contractor`s Name P -.• ------------------------------ Phone---- -------------------•---•-_--- f+ t House ❑ E] Trailer Court ❑ Motel [-IOtherE]installation will serve: Residence�Apartmen Commercial,,, Number of living units: _1___.-'Number of bedrooms _--'1' N'umber of baths -1_-_ Lot size -----_�------t?_Q___-X."2._Q-0------------- Water Supply: Public system E] Community lsystem ❑ Private EY, Depth to Water Table 1.6 ft. �} Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe`[ ` Hardpan ❑ Previous Application Made: Yes E] No 0New Construction: Yes n' No El TYPE OF INSTALLATION AND SPECIFICATIONS: ` (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �1 Y Septic Tank: Distance from nearest well-#'_Z0---_Distance,from foundation____1_d___._.Material_____ !'`t [ No, of compartments-_-_-_--_ —---------- / _ t __ __Liquid depth_-.__ _ f�,l'_Capacity___ r�r__n ___-Distance to nearest 1 t li Disposal Field: Distance from Weare t well._�__�_0-_Distance from foundation_,,__ff �� Number of lines-- �--_---.,.-.I_____-____ __Length of each line_2��.T:�'_�'-*Width of trench___-�--�_____-___________ Y Type or filter materiaL_.S_rI.Depth of filter material----;?__b-_`f'....Total length------�_)_________________________ Seepage Pit: Distance to nearest well......:k--------------Distance from foundation------------------- Distance to nearest lot line----------------- [I Number of pits--------------------I Lining material-----------------------Size: Diameter------------ -Depth.-------------------------------- Cesspool: Distance from nearest well. Distance from foundation--------------------Lining material-------------------.----------------- ❑ Size: Diameter--------------------- - -Depth-------------------------------------------- Liquid Capacity----------------------------gals.,---x .�_ _ Privy: Distance from nearest -------------------------------------------Distance from nearest building-----------------------------------------.d ❑ Distance to nearest lot line --------------------------------------------------------•-----------------------------------•------------------------------•---------------- 'I Remodeling and/or repairing (describe):--------- d.-- -----------------------------• ------------- --•-----------•-------- -----------------------------------------------------�` --------------- -•-•-----------------------------------------------------------i-------- --------------------. . ----------------- -..___-------- � li I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. e (Signed)._---•------r- ----,- --------- •-_-------_._. -----,.- - � --------.- -------_- -•- ------------------------ - (Owner and/or Contractor) By:----------------------------------------------------------------------------------------- ----------------------------------------(Title)------------------------------------•--------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). } FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY---- --------------^-------------------- ----------------------- DATE------------------------------------------------------------ REVIEWED BY---------------------------------- - ��1 �,� ----- DATE------ - BUILDING PERMIT ISSUED---_- (R- y'------------------------------ DATE. --------------•----•------------ Alterationsand/or recommendations---- --------- ------------------------------------•------ ------------------------------•-------•--------------------------------•------------------ ----------------------------•-----------------------•---------------------- ------------------_-----------------------------------------------------•------------------------------•-------------------------------- ---------------------------- ----------------------------------------------'f---------------------------------------------------------------------------•--------•---------------------••-------------------------------- -------- ----------------- - --------- ----- ------ --------------------------------- ----- • --------- ------• ---------------------------------------------- FINAL INSPECTION BY:. Date------------------------- ------------------------------ SAN.I JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wes# Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5---9-2M I45446 ATWOOD 12-54 -