7629 - Laserfiche WebLink

Home Browse Search

1APPLICATION FOR SANITATION PERMIT Permit No. (Cornplete in Duplicate) Date Issued Applicakion 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 withY _ ---------------------------------------------------- ----------------------- 49. 1 JOB ADDRESS ANDr�tOCATION .� Phone-------------------------- -- s Owner's Name.----- ! -------------------------- F -• --------------• -------- ; Address O � l� .._.. Phone-- ->� Contractor's Name.___ Installation will serve: Residence � Apartment House ❑ Commercial ❑ Trailer Court ❑ Motef❑ Other ❑ a /a.gF-------------------- Number of living units: __.__ _ Number of be ____zNumber of baths __-/__ Lot size ____ _____.-- Communit s stem ❑ Private U?IOepth to Water Table -------- ft. Water Supply: Public system ❑ Y Y Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe tp---Hardpan ❑ t ,` Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ o ❑ W TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 240 feet.) Septic Tank: 1 Distance from nearest well_________________Distance from foundation__.__.____-___.__..Material-________---.__ _.-___ -:_--.=---------------- Sept ----- ❑�"31i5T172 No. of compartments-__ -----------------Size--------- ---•--------------•Liquid depth--------------------------Capacity O Distance from foundation.." ------------------ Number to nearest lot line___ __ ___. Disposal Field: Distance from nearest well..,,:j-._.__. Number of lines----------------��----------Length of each line---SIP---- Width of trench_----•---�--y ,5----------------------- R Depth of filter material----- length____.---- - Type or filter material__+/ ---- -- P Seepage Pit: Distance to nearest well------------ --------Distance from foundation Diameter.... -- stance to nearest lot line ---------- 1 Number of pits____--__ ._____Lining material____ ___-.._ ❑. ---------- Cesspool: Distance from nearest well-----------------Distance from foundation___- .__ __...__ .Lining material Depth --Liquid Capacity----------------------------gals. ❑ Size: Diameter------------- -------- ------- -- p -:- -:_Distance from nearest building---------------------------------------- _ Privy: Distance from nearest well------------------------- ----------- ❑ Distance to nearest lot.line------------------ --------------------------------------------- -ly---------------- �Jd f .f e�r x ... -- R: ------------------------- Remodeling and/or repairing (describe):'_.---J7------ ____.___ -----•-------•------ •---- ------ -- h is -------------------------------- -------- -- 9 County I hereby cer ifyNsho ah ules�andaregulattons olf the San Joaquin Local kHeal Health accordance with San Joaquin nun ordinances, St a a , Si ned ------- --------------- ner and/or Contractor) (Sig �d ned)--_- '#I ------------------------------------ ------•------------- _(Ti(Title) , (Plot plan, showing size of lot,rlocation of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY - - ---•--------•-------------- DATE-------- ----- ------------------------------------- APPLICATION ACCEPTED BY DATE REVIEWED BY------------------------------------------ 1. -------------------------- DA BUILDING PERMIT ISSUED------------------------------------------ ------ ----------------------------------------- --------------•---- - -------- ---• ----------------- Alterations and/or recommendations______________ ____ __ --------------------------------------------------` -_-__---._.-...___.._.___ ----------------------------------------- --- ------------------------------ --------------- - Date------------- ---:_ ..........S_M4----------------------- FINAL INSPECTION :-------------------------- ----------------------- SAN -------- -------•-------SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "G" Street 130 South American Street 300 Wast Oak Street Tracy, California Stockton, California Lodi, California Mlen+eca, California y� E5-9-2M 141446 ATWOOD 12.54