7051 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT P rmit No. ....7e_�`�__.�... (Complete in Duplicate) -� Date Issued Applica+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. JOB ADDRESS AND LOCATION........../ `7"-.--- - --......-CnC.�r----------------------------------------------------------------------- a @ b Owner's Name.------ - - -• ------ -----•--- ----- -------------------------------------------- Phone------------------------------ Address---------------------_---------- ....................-.............................................---------•--------------•-----------------------------....------....--............................... Contractor's Name - --- . -- . --------------------------------------------------------- y Installation will serve: Residence [I-'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Numberof living units: _j--- Number of bedrooms ...';Z.-Number of baths ..../_ Lot size -__ .....A_- 6.'_t?------------------------ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 91� Hardpan ❑ Previous Application Made: Yes ❑ No [ New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: P.4stance from nearest well__;---------------Distance from foundation--------------------Material------------------------------------------- __.:.. ❑ K f compartments---------- ------Size--------------------------------Liquid depth_--..------------------•--Capacity----------------------- Disposal Field: t nce from nearest well-----------------Distance from foundation_____----_____-:-_.Distance to nearest lot line................. El of lines-----------------------------------Length of each line-----------------------------.Width of trench----------------------------------- Type i ter material_________________________Depth of filter material-----------------------Total length.......................................... •J Seepage Pit: Distance to nearest well---------------------- from foundation_..._... ......_.Distance to nearest lot line................. 0 ❑ Number of pits----------------------Lining material...........------------Size: Diameter-----.--.-_----_.----Depth--------------------------------- Cesspool: Distance from nearest well................Distance from foundation------------------_Lining material---------------------------------- .. ElSize: Diameter------------------ --- .-- ----- ----Depth------------------ - ---- ---- ---- --------_Liquid Capacity---------------------------gals. �' Privy: Distance from nearest well __-_----_.--------------------------------------Distance from nearest building----------.._..........................._. N ❑ Distance to nearest lot line ------•----------- �. P Remodelin and/or repairing (describe):_ ° -- -------------------------------------------- !?< - � - �---- - -- -- --------- ----- .� --- - ---- - - --- - --- -- ------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State and rules and regulations of the San Joaquin Local Health District. (Signed)------ ---- �.,•'d,-------•------- --- ----------------------------o-------(Owwnner and/or Contractor) r v By:. (rifle)----- ----------- (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 .y APPLICATION ACCEPTED BY------------ ------- = ------------....... DATE------�:................................... ------------ REVIEWEDBY------------------------------------------------------ --- DATE---------- -- BUILDING PERMIT ISSUED------------------------------------____ ___ DATE_________...---- ._-. Alterations and/or recommendations-------------------------- Icl------••-------------•------------•-----•---•-•--•---••------•----•------•------ �.�,�^^ ---------.•--------------------------------------------•--------------------------------------------------------------------------------------------------..........---------------------•----....------•-----------------•-- ------------------------------------------__------------ -- ------....------------------------....._.. ......---.. ............................................................. FINAL INSPECTION BY:-- --- -- Date . .a ... --•- •----------•--•-- 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 145446 ATWOOD 12-54