7971 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No.. . .? (Complete in Duplicate) ori R. J Date Issued .................. ?jAplica+ion is hereby made to ocathe San Joaquin Ll Health District for a permit to construct and install the work herein described. s application is made in compliance my Ordinance No. 549. v. ?-?`� ��. 'S�"-1c c.�d-'------- -------------------------- JOB ADDRESS AND LOCAT O Owner's Name .�--`--'4 •----------------------- 17� c3 ---.�U --A Phone Address............................................................... Contractor's Name -----------------•-----------------•---"-------------------------------•----------------- Phone................................... Installation will serve: Residence g, Apartment House ❑ Commercial [Trailer SOW ❑ Motel ❑ Other ❑ Number of living units: I-_-- Number of bedrooms _"- Number of baths ._f____ Lot size ---------- ......................... Water Supply: Public system. 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[Z 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: Distance from nearest well___ _______Distance from foundationy-A............Matef�ial------ ! No. of compartments_.______"._.__-.Size___ liquid depth________T__.___----Capacity....�.4.�.. Disposal Field: Distance from nearest well"__."- -------Distance from foundation.._...e .......Distance to nearest lot line------- ...._... Number of lines_________________/.__._ _._____._.Length of each line----------- °---------Width of trench--------------24'_.x........ Type of filter material- -- +�'- Depth of filter material_"".-_-:-?-"-__-"Total length--------------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line_"-________-___-- \' ❑ Number of pits--------------_-------Lining material-----------------------Size: Diameter-----------------------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----------------------------------------------------------------------- ------U------------.----------------•----------Z--------�------ --•---- Remodeling and/or repairing (describe):_____ -_-.--__ 2 . . -----------------------•--------------•-------------------------------------------------------------------------------------------------------"---------------------...------------...---"-----------•--------•---••---------- -------------------------------------------------------------------------•-------------------------------------------------------------------------------------•-------------------------------- ------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S+a a laws, an n rules and rreg�ulaations. f the San Joaquin Local Health District. !f L�/ I (Signed)--- Kowing - -�---- �Gf--- --- - ---- -- - - k - ------------------ --------- ---------(Owner and/or Contractor) (Plot plan, s size of lot, location of system in relation to wells, buildings, etc., cin be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- ----------- ........................................... DATE------------- . REVIEWED BY------------------------------------- -------- -------- --- -------------- -n''-------------------------..--- DATE----"-------....----------------------------- --------- BUILDING PERMIT ISSUED............................ - 4 - -------------------- DATE---------------------------------------------------........ Alt rations and/or recommendations:-- ...,l -S-------- --- ... !�`.. � �ro-��*- - •• -- -. .-.�x.---lL?.1'�'�... _ Jl_'.Qye�.�a__ ,rX--f✓.-�G3�---�/-�fjL--�-'�-'-�P-sr�s-S.Y'---�.'-C'�, ` � l ' °`" ------ ----------- --------------------""-------------------------...----------------•----------.................................... ----------------------------------------- ------------------------------- ------ .....................-.............................. FINAL INSPECTION BY:. ------ Date------- I / "5 ----------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300.Wesf Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi,California Manteca, California Tracy, California ES-9-2M 145446 ATWOOO 12-54 '