6367 - Laserfiche WebLink

Home Browse Search

1� APPLICATION FOR SANITATION PERMIT Permit No. .__(52-- "°'..-...•. (Complete in Duplicate) �.�. 75-6 Il Date Issued ----:-3�-�'-- Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. l This application is made in compliance with County Ordinance No. 549J 1 ,s JOB ADDRESS A D LOCATION-. _ ---------It 5 � -- ------------- ------ ---------•----------------------------•---------------------- Owner's Name-- -----o ---------------- - Phone P - Address---------...qzD --- ----------------- ----- -------------------------------------------------------------- *-----•---- -------- Contractor's Name--- -- --------------------- ...-•-------- I honef`�_°..+,� Z-6_-1--P_ Installation will serve: Residence. artment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J__ Number of bedrooms _-2-Number of baths -_J.__ Lot size ¢ ,�Q____ ._____ -0-- ------ Water Supply: Public system�+unity system El Private ❑ Depth to Water Tablet,,)-0- ff. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam❑ Clay ❑ .Adobear pan Previous Application Made: Yes ❑ No [4---h*w-Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: ,(No..septic,fank.or cesspool permitted if public sewer is available within 200 feet.) r Septic Tanl•: Distance from nearest,well__---------------Distance from foundation------------.------Material---------------------------------.-------- ..____. No. of compartments-.'-------- ----- ---.Size--------------------- ------Liquid depth----------------- --------Capacity.----------•----------- 0 - - _ of isposal Fie! Distance,from.nearest well-----------------Distance-from-foundation_______;--t Distance•to nearest lot line----------------- " Number of lines -.*-------------------------------Length of each line------------------------------Width of trench-----r----------------------------- Type of filter material__'..-_: -Depth of filter material_______._.----------Total length________________________________________ �I�umber of its- -___. l: t Seepages e Pit: Distance topnearest well _._._Disfance om foundation__�a.._.___-Distance to nearest lot line----/_0_____- p,J, i _Linm material_ . __ -Size: Djameter__._33 r`_..____Depths Cesspool: Distance from nearest well-----------------Distance from foundation__ "--------------.Lining material___.___..___-__-________.___________.. ❑ Size- Diameter----- -------------------- Depth--'. ----------- ------Liquid Capacity-- ------------------------gals. Privy: Distance from nearest well---------------------------- ------------------Distance from nearest building---------------------------------- ....... -- - ❑ Distance to nearest lot line I Remodelingand/or repairing (describe):-- --------------------j----------------------------------------------------------.----------- --•----•--------•--------------------------------------- ------------------------------------------------------------------------------------------------------------------------- T j' __________________________________ ___..__._ -------------_------_--------------------_---------------------------_---------------------- -------------------------- ______________________________________________ ___ . -It - -.. --.rte —1Aereby,certify•that"I-have prepared-this•application and ihat.fhe.work.will..be.done.an accordance.with-San Joaquin..Counfy X ordinances, State laws, and rules and regulatio of the San Joaquin Local Health District. (Signed)- - - - - ------------ -------- ------------------- --------- -----------(Owner an 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 ,�r APPLICATION ACCEPTED BY ---------------- DATE V� __. REVIEWEDBY-------------------------------- ---- -- - ---- ----- --------------------------------------------------------------- DATE-------•----------• - ----..__.-... -•---- BUILDING PERMIT ISSUED--------------------- ------ ------------ ------------------•- DATEe Alterations and/or recommendations------------ ----------- --- _-- ----------------------- - ---------••-------------------------•--------•------------------------ ---.S-"------------ -----------------------------------•--------°-•----- ------•-----------------------------------------------------------•--------- ----•----------•- ---------------------------------------------------..--------------------- ----------------------- Date-FINAL INSPECTION BY:-.__ -- ---------------------------- - 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 ES-9-2M 745446 ATWOOD 12-54