7702 - Laserfiche WebLink

Home Browse Search

3 i d d 1 APPLICATION FOR SANITATION PERMIT Permit No. ...z-7 --_-•_ (Complete in Duplicate) Date Issued " " 5 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.compli nce with County Ordinance No. 549. ��3� I JOB ADDRESS AND LOCATION_3.90CAe�, IC----= `1 II---- C� ------------------------ Owner's Name-- 0-2------;77�----- }_ '/�58_� �------------------- ----------------------------- ----------- - Phone/g., -----------_ Address. � . --_,� _ ....................... •.............. ----------------------------------------------- Contractor's Name--- _ l3 .. ^. / ---------------I-----------------------------------------------••---------------------- Phone.A4----4-5_462___ Installation will serve: Residence al`_�Partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 4 Number of living units: __ ____ Number of bedrooms --,3. Number of baths .__-.41 Lot size .___---. Water Supply: Public system'❑ Community system ❑ Private Rg--�6epth to'Water Table -------- ft. Cv Character of soil to a depth of 3 feet: Sand ❑ Gravel ElSandy Loam ❑ Clay Loam E] Clay ❑ Adobe gj—'Hardpan E]Previous Application Made: Yes ❑ No - Construction: Yes e-<0 ❑ v. s _ TYPE OF INSTALLATION AND SPECIFICATIONS: _ r (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ^/ f f Septic T Distance from nearest well.-.-73_--_--Distance from foundation___ /O--._-__.Material--.--- _ �-------" _--------------- ------- r-e_ --- No. of compartments-- -f 4- --.----Size_-.'45 ��_- �`rLiquid depth----=--� �r_----._CapacitY--- °�.d---d----• - p I / r �D r / Dis osal ld: Distance from nearest welL. �-_--..Distance from foundatior_r_ .----_-_-_ Distance to nearest lot line________... , If Number of lines-_-.-t------ . !i f .�..-y--.�.------_--Length of each line-�J_._.___ -�-- Width of trench---.---%�-Sf-------------------- Type of filter mate�iai__._E#/ Depth of fiiter�material---._/�-----.-_.Total length---------7 ---------------------- Seepage ' : Distance to nearest well_ ±Q- -_-_-Distance from 'foundation----- Distance to nearest lot line_--57-.__._. 12 Ni �r umber of pits..__..:._t__------._Lining material____�t-�C_Or .Size: Diameter_ ZDeptn--_. ��-------------------- Cesspool: Distance from nearest -st well-----------------Distance from foundation______.-------_-.-. Lining material---_.----_----.-____----_------_--_-_. ❑ Size: Diameter--- JI---------- --- ---------------Depth---------------------------------------------------Liquid Capacity- --------------------------gals. Privy: Distance from nearest well------------------------------------ ______________Distance from neares# building------------------------------------------ ❑ Distance to near`estaot line _- ------------ . ------------------------------------------------------------•------------------------------------------------------ Remodeling and/or repairing (describe):----./Y C/- 77E ----••-----•---------•----------:--------•--------------- •--•--•--------------------------------------------------- ----------------------------------------- fl ---------;-----------•----•----------------------------••-I--------------------------------------------------------------•------------------------------------------------•-- ------------------- ----- {� ------------------------------------- -----------------•--------------------------------------•---------------------------•-•-------------------•-----------------------------------------•----------7----------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)------ ---4 X,104 /R/C 'r t. ---- -------------------------------------------------------------------- ------- nor and/or Contractor) .r A�ofl, BY: -------------------------(Title)---- -: --- -•-•'----------------------------------- (Plot plan, showing silocation of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- -- -- -------------------------------------------------------- DATE-- REVIEWED ATE-REVIEWED BY ----------- ----- -- --------- -- ----------------------------------------------------- DATE------`- BUILDING PERMIT ISSUED---------------------------- --- - ---- DATE-- Alterations and/or - Alterations and/or recommendations:....._................. ---------------------------------- --------------------------------------r ------------------------- ---------------------------------------------------------- FINAL INSPECTION BY:.._ -------------------------------------- Date_._...` ._'__.__. --1.T 5 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