7683 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. ....... (Complete in Duplicate) 1p n Date Issued _-----__---s__ I' anion is hereby made t h n Joaquin Local Health District for permit to construct and install the work herei ` ribed. App is y o the $a This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION__.._1 _._ �__.CI ,r�. __ Y'_ ._.l`i__ _ _ _Q. `f'.� !-�!..`.... _ .____ .�/ � - Owner's Name sL.11,lset.E'.- ----- ----------- ---- -------------- - Phone. C ......... Address...........&0..-,L.7---- j Contractor's Name------41: ------------------------- ----------------------------------------------------- - -•--- Phone......................... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __J---- Number of bedrooms Number of baths __I__. Lot size ___L�____....Y8....1_a.0.................... Water Supply: Public system X Community system ❑ Private ❑ Depth to Water Table -------- ft. ► Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan Previous Application Made: Yes ❑ No 4, New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Setic Tank: Distance from nearest wel "A-9.Distance from foundation---J_0._...... _ Mat ria[__- - t Y 2_-. @__--•__ _._�No. of compartments.... ------------Size--- xLiquid de th._-.. ---- ---__--_Ca aci Disposal Field: Distance from nearest well"0740Distance from foundation---L_Q----t__.Distance , to nearest lot line._-��.... Number of lines----41-Z-4R........_______L thh off.each line...../._` .Qn--_-__--.-.Width of trench--r_�,)...�_-�•-____------ -< _.___- ` Type of filter material ter material X-y Total length-- Seepage Pit: Distance to nearest wel -------------Distance from foundation....................Distance to nearest lot line----------------- R Number of pits----------------------Lining material------.................Size: Diameter-----------------------Depth--------------------------- --- Cesspool: Distance from nearest well-----------------Distance from foundation-----------------_Lining material-------------------.................. ❑ Size: Diameter--------------------------------------Depth-----_----•---• ----------------------------------Liquid Capacity----------------------------galls 1 Privy: Distance from nearest well-------------___---------________________________Distance from nearest building-------------............................. ❑ Distance to nearest lot line----------------------------------------------------7------------------------- -.-------------•------••---------- ----•--•--- Remodelin and/or repairin des ib --••------ ------ ........-•._......._ ••... I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Coun ordinances, Pte laws,,,And rules and r ions of t San Joaquin Local Health District. (Signed ---- v__,__------------------ --•- ----- ------------------------------------------------------------ ---- .----------.(Owner and/or Contractor) By:........................................................•- ------------------------------------------------......................(rifle) ---------------------------------------------------------- (Plot plan, showing size of lot, location of stem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---.-.- ------ --- -------- --------------- DATE----- ------ REVIEWEDBY---------------------------------- ------ DATE-------------- - ................................... BUILDINGPERMIT ISSUED----------------------------------- . --- ...................................................... DATE------------ ......4-1---------•---•--------•--•-•---•- Alterations and/or recommendations----------------- % V . -------••-•--••--•••- -•-- ------ ------------------- ---•--- ` ---------------------------------------------------------•-•---------------------------------------- • FINAL INSPECTION BY--------- ---------------- ----------------------•----- Date------l- .�-----'----� ��------=%-------------........................ 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-9145446 ATWOOD