7985 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. ..._!._!_.�... (Complete in Duplicate) �J _ Date Issued _�1_ r---•__ Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. i This application is made in compliance with County Ordinance No. 549. -A? o � (,rTUf JOB ADDRESS r OCATION---__ i/✓C Owner's Name---- 4/6c5 UJ /.J-R �/��y-ti$ja�9 S c�NsR: - Phone-__.____________ _______________: Address _IQ--------------------------------------• ------- Contractor's Name------- 1_S�1 _ r ` --------------------- Phone.. Installation will serve: eence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livingNumber of bedrooms --3-units: ___1-- _ Number of baths ---- tot size z --- Water Supply: Public system ❑ Community system [L}��ivate ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [l Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No Eff--'Re'w Construction: Yes moo..❑ TYPE OF INSTALLATION AND SPECIFICATIONS: 3 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well O- P Distance from foundation----._4Q_._ __.Material------- ---------- ---------- -x--__------ No. of compartments_____--)'-4>__0...Size__:1 _.__�` _ �'--Liquid depth_ ................CapacitY__/Odi 'rf.L Disposal N Id: Distance from nearest weII U ---Distance from foundation___-/--©......Distance to nearest lot line_______ Number of lines__________ ."c---------Length of each line+lb- -- -.Width of trench--------- --" 3 Type of filter materi Depth of filter material Total length_____•,. ------------- Seepage -•-•-- Pit: Distance to nearest welt----------------------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--- ---------------- material--------------------,--_.___. -------- 1 ❑ Size: Diameter--------------------------------- ----Depth.------------- ----------------------- -------------Liquid Capacity._.._ gals. ------------------ Privy: Distance from nearest well----------_--------------------------------------Distance from nearest building _ El Distance to nearest lot line-----.._.._________________ Remodeling and/or repairing (describe):_...__-/ � /eJE -- --- -'Ll r.. I - --------------------------------------------------------- -...... =-------------= --------------------------------- --------------------------------------------------------------I— -----------------------------------------------••-------------- - - -•- ----------- -------------------------------------------------------------------------------------------------------------------------------- -------------------•------------------------------------------ I hereby cert�'f al'd have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Staft law , and rules and regulations of. the San Joaquin Local Health District. '"�"`` •�-�_, {Signed) . - --- �� s / �C r �or t ) - ... ( w eac or By:... -- -- --- - (Title} ------------------ -------------------- (Plot plan, showing size of lot, location o system in relation to wells, buildings, etc., can be placed on reverse side). T FOR DEPARTMENT USE ONLY APPLICATION ACCs PTSD BY. --------- -------- ------------------- ; rf!, .,-'_-`,DfCT� REVIEWED BY --------•------• D E)�4'--�-----------•---•--- - { - ;= ' BUILDING PERMIT ISSUED------------1�j----------------- ----------- -- - --•----------•------------ D TE ------- Alterations and/or recommendations:--..--------------------------- ----------•-----------------------•----------------------------------------.-------------------__._.-----------------------•-------- ----------------------•----- --•-------•---•-------------------•------ --- ----- ------------------------------------- ---•---------------------- ---------------- --- FINAL INSPECTION BY:- - `'t'f'r'-* - --`A-`-`-� Date....... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 30D West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9 145446 ATWOOD - ij.