8481 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit o. .... y0./. (Complete in Duplicate) Date Issued A plica+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 compliance with County Ordinance No. 549. 4 JOB ADDRESS AND LOCATION---•.=� -• ,9----�'1'-�------ -----------------------------------------•---_-•_----------------•----•---_------- Owner's Name........ w'-. ..... .'.---•---------•---------------------------- -------------------------------------------- Phone.................................... Address.............. sL - ... Contractor's Name... ------------ � -�------------------ Phone................................... Installation will serve: Residence 9''Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---Z. Number of bedrooms -./i.. Number of baths ---f__ Lot size .__.4t..<-:4----- -------.--..._---- i Water Supply: Public system Community system [:] Private ❑ Depth to Water Table yir ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe&--glardpan ❑ Previous Application Made: Yes ❑ No Fa-"'New Construction: Yes ❑. No g4 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewerAs available within 200 feet.) Septic Tank: Distance from nearest well from foundation--.-..-&.......Material-----�a_��. ._-_-.. . C�.---.. � rNo. of compartments.._.__. .._._-.-._.-. Liquid clepth_._ g- -___--.--.-Capacity---------------------- yy ��"df f Disposal Field: Distance from nearest well__)711_-'� istance from foundation..Ae-----....Distance to nearest lot I- Number _-_.... Number of lines-.......f----------- ,Length of each line----- ------- 7----Width of trench------.- . 1-------- ------ Type of filter material./� __. _. _ ._ ._ epth of filter material----/�_.--------Total length........®- .• 1 Seepage Pit: Distance to nearest well---- t` c _`Distanc/e�fro foun tion.-.gin?----------.Distance to nearest lot line-..- Number of pits__._.�..._....._._Lining material[ . ize: Diameter_.r �. _.�`-_..._Depth------- .............. 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---------- ------------------ ----------------------............. •---------- ...---.-.-.-.....------------------------------------------- Remodeling and/or repairing (describe)------ 411_Z --- ---- -------- ------.--_-.---_-----•-------•------•----•----•-------.-- J --•------------------------•-----•-•---•--••----•-•--•-_---•. ------------•---•------------..........................................§f-------•------•-••-•_-----------------•---------------•...._-•--------•• --------- -----•------------•-----------------------------------•-----------•-•---------•--------- ..................................................................... -•------------------------•------•----------.----------------- 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. (Signed)------------- P-ks.....-vr.` 4.V`Cyc-- --------------------------------------------------- r Contractor) By: -- -- :.......... • . --------------------------------------------------Title Y• - -- - - -- ---- -- ---- - - -- (Title) --' ---------------------- (Plot plan, showing size of lot, I cd ation of system in relation to wells, buildings, etc., can be placed on rever side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --------------------- ------ DATE ------------------------------------- REVIEWEDBY ------------------------- -----------------=---------------------------------...... DATE....... -•_---.. -_ ---------------------•---••--..... BUILDING PERMIT ISSUED............------------ --------------------------------------------------- DATE............. -----••-�--- . ......................... Alterations and/or recommendations:--------- - ----- ------_•-__----•-----•---•_-_•-------•------------•--•-••------------ -•-_-•. -- ----- - ----�a ---Q ----- ------ --- -------------------------------- ---- .... .--- - >w....... ------------------ ---------------- -------- -------------------------------- - --- --------- ---------------------•----------•------------------------------------------------- .......................................... FINAL INSPECTION BY:...... ,., ------------------------ ---------- Date.--- -~ �� C� - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street a Stockton, California Lodi, California Manteca, California Tracy, California ES-9 145446 ATWOOD