7428 - Laserfiche WebLink

Home Browse Search

-Z-.O-_ (Complete APPLICATION FOR SANITATION PERMIT Permit No. --1- in Duplicate) 0 Date Issued .-_- 111 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.t� JOB ADDRESS PA LOCATION-------- _48- Owner's Name._ Ori'�v-----k--"f -1_x.,5/ -------------- ------------------------------------------- PhoneAddress. �f.?. -W---F'---------------------------------------------------------------------------------------------------------------------------------------- --- ---- -------------- -- / Contractor's Name---- ---�./7..t1..c-��n ..J c31+�------------ -------------------------------- Phone Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: A----- Number of bedrooms ----/.- Number of baths /----- Lot size -------4!_o---- --------------------_-------- Water Supply: Public system D2_ Community system ❑ Private ❑ Depth to Water Table -,.I0___ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe & Hardpan ❑ Previous Application Made: Yes ❑ No RL New Construction: Yes LA, No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank:01 Ai once from nearest well_________________Distance from foundation-------------------.Material------------------------------------------------- ❑ f compartments - Size--------------------------------Liquid depth--------------------------Capacity----------------------- Disposal Field: - Di tante from nearest well_________________Distance from foundation--------------------Distance to nearest lot line-----__-.-------. ❑ er of lines-----------------------------------Length of each line------------------------------Width of trench----------------------------------- T of filter material------------------------- of filter material----------------------- length-.__------------------------------------- Seepage Pit: Distance to nearest well___/A/&7_- ..-Distance from foundation--,-Ce-----------Distan`e to nearest lot line...... [� Number of pits-----1-_.-._____._Lining material�j__e___�.�,< Diameter--- -- ...__......Depth____Z ----------------- }� Cesspool: Distance from nearest well-----------------Distance from foundation---------------.----Lining material--------------------------- ----------- 'y ❑ Size: Diameter--------------------------------------Depth----- --------------------------------------------Liquid Capacity---------------------------- gals. Privy: Distance from nearest well--------------_---------------------_------------Distance from nearest building-______.--.--__------------.--.--__----.-. `V ❑ Distance to nearest lot line------ ------------ ---------------------------------------------------- -------------------- ----------------------------------------- Remodeling 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) -- ----------------------------------------------------------------------(Owner and/or Contractor) By:-- -------------------------------(Title)... ---------------------------------------- --- -- s�` (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 APPLICATIONACCEPTED BY--- ----------------------------- ---------------------------------------- DATE---------------- --------------------------------- REVIEWED BY----------- - DATE------ ---- ---------------- - - BUILDINGPERMIT ISSUED----------- - ------------------------Q ----------- DATE--------------------- ------------------------- Alterationsand/or recommendations----------- ---------------------------------------...---------------------------------------------------------------------------------------- ----------------- -----I----------------------------------------------- --------------------------------------------------------------------- --------------------------- ------•-----------------------------------------------------------------------------------------.---- --------------------------------------------------------------I--- ---------- -------------------- ---------------- -------------------------------------------- --------------------- ------------ ---------------------------- ------------------------- ------- ----------------- ---------------------------------- ---------------------- - ---------------------------------- ---------------------------- --------------------- --------- -- -------- --- FINAL INSPECTION BY:. - Date------------- tl 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 E5-9-2M 145446 ATWOOD 12-54