6667 - Laserfiche WebLink

Home Browse Search

rte" 5 J Permit No. ...fL..S�.L.� APPLICATION FOR SANITATION PERMIT ----- t' (Complete in Duplicate)' - Date Issued A lica+ion is hereb made tO le San Joaquin Local Health District or a permit to construct and install the work herein described. Thpsapplicationis made in compliance with County Ordinance No 49. JOB ADDRESS AND A -------------------------------------------- �-•-�---!-------••--- _ --------.---• --- ----------_------•--••------•------_---- Phe --Owner's Name -tS� Address----- g� ................................................. ---------------------------------------------------•---------------------------------- Contractor's 'Name------------•••. ----------------------------------------------------------------------------------------- Phone.--------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ /Motel ❑ Other ❑ Number of living units: _�.___ Number of bedrooms .�... Number of baths •/-___ Lot size ,"__ __/ ..4•P-------------•--------------- Water Supply: Public system Community system ElPrivate ❑ Depth to Water Tablet ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 1( Hardpan ❑ Previous Application Made: Yes E] No New Construction: Yex No E]TYPE OF INSTALLATION AND SPE IFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest Distanc .from fc?undation.�s-_____-.M trial____ __ ___ __ ____ __ ------------- -_ __.--_•---. No. of compartments._ ________________Size __W— ,10W uid depth.�__�3_�____Capacity_.•_-_•------ _ Disposal Field: Distance from nearest welll�`�'�Distance from foundation.-•_ .Lt*-...._.Distance to nearest lot line_ _. �__. - _____Length of each line___.... --.-.Width of trench.___..ze� !________________ Number of lines______/-------------------- --Q------- 1_ Type of filter materia _Depth of filter material----�/_?`'.._...Total length-------_..�r1_'.................. Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line----_-._-__-____- ❑ Number of pits______________________Lining material-----------------------Size: Diameter----------.------------Depth-_.__-.-_-___-______•-__________- S Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--___.-___-__-__-.--.__--_-____---_-_. Size: Diameter-------------------------------------Depth-------- ------Liquid Capacity--•-------------------------gals. IL Privy: Distance from nearest well.___-___________________________---__----.--_-Distance from nearest building--_-._-•--____•- _•-----..-_-___-- ---4 ❑ Distance to nearest lot line-------------------------------------------------------------- ----- ----------•----------- ----•-------- Remodelin nd/ r repairing (describe):__-- � E"�. . ••• . ---- •••� --+ ---•- ....................... •------•-•----•---•-••-.---- •-----••-•••••-•--•----•---••-•-••••----••--•-----•--••--•-••••--•-•--•-••--•••-•-----•--••--••------••-•-•--•-•-•••..........................•--• I hereby certify that I ha v prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State , and s d regulations of the San Joaquin Local Health District. (Signed) ------------------------------------- - -------------•-_----- ---------------------------- . Owner and/or Contractor) By:. (Title)------------( )------ -- (Plot plan, showing s' of lot, location of system in relation to wells, buildings, etc., can be pl ced o verse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY-------_--------------- -- --------------------------------------------------------- DATE. -----------------------=------------------------ REViEWED BY ---------------------- DATE-��-- ..................... REVIEWED PERMIT ISSUED-------__-_--------- ---- -------------- DATE. Alterations and/or recommendations--------------- --------- --------------- . •-•-••••---••--•---•---•---••------••---•---•••---•-----------•-•-•.....--•••--••--•------------......•-•••-... /--------------X_eoff4-•-••4...-e-------►.p.7...... --•----------------------------------- ------------------------------------------------------------------- ---------- ---- --------- ----------------------- -•-- --..------------ --- -----•-------------------------•-------- --------------------------------------A..............A/p--�_�'e��,�rr�}----- �-.. �� a°� ��y.� ----- �1 -- ) Z% ` --------•------------------------------- FINAL INSPECTION BY----------------------- --------- ----_--------------- Date.... 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