7844 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIY Permit No. _.7.)--- (Complete in Duplicate) j` y bate Issued `---------- Applica�ion is hereby made to the San Joaquin Local Health.District for a permit to construct An install thew rk h rein described. This application is made in compliance with County Ordinance No. 549. � � r 11 f JOB ADDRESS AND LOCATION,------- J_1�-1�d�_�----- Z'....-�------�°--r------ /--------------------------------------- Owner's Name........OAYV-------fw- .]---------�t a ZV.`5.-1----••- e—&-=--------------------------------------------------- Phone------------------------------------- Address--------... 0. ------./A/0 ------GJ•W A-------------------------------------------------------------------------------- ---------------------------�] - ------ �I Contractor's Name...--. �-�-`-----1'�-��--�----� -•-�C�-�-�--------------------- ----------- Phone....................... Installation will serve: Residence W Apartment House ❑ Commercial [❑ Trailer Court ❑ Motel ❑ Other ❑ c Number of living units: ___I___ Number of bedrooms __..- Number of baths _%_ . Lot size _- �. -- -- ----------------- Water SuPPIY� Publico system Community system � Private ❑� Depth to Water Table _0 ft: Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑, Clay Loam ❑ Clay ❑ Adobe® Hardpan ❑ Previous Application Made: Yes ❑ No W— New Construction: Yes gL No ❑ r 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 foundation --------------------- --'- ----------- _-Waterai_____ No, of compartments....... ___Size------- _ 574_x_,.57T._Li uid de th..._: v_,_ Capacity-J414-0 Disposal Field: Distance from nearest well____ .0'0.f_Distance from foundation------ � _�...Distance to nearest lot line- [� Number of lines----------I------- -fr---------Length of each line---------7.'!!T ___..;._.._.Width of trench-------�.- f.4............. Type of filter material.-J-1 ---.A—Depth of filter material-___.__/._____..Total length--------7_5�......................... Seepage Pit: Distance to nearest well_.___�a_-_f__'_`Distance from foundation_______1_C. .._..Distance to nearest lot line-___�? Number of pits--_-____:�.____-- --Lining material-_G_c. �s Diameter.__ rze: r . -------Dept h----.2-15 I , Cesspool: Distance from nearest"well-_._______.___`_Distance from foundation—__________......Lining material__._..__-- _-..-_ - ❑ Size: Diameter------ 4----------=--------:--.----_.Depth---------------------- -----------------------------Liquid Capacity----------------------- -gals. x Privy: Distance from nearest well_..._...__.___.._" -------.............:...Distance from nearest building____.:`____________________ ]] Distance to nearest lot line------------------------ `" "---------------'* -" ---------------------- Remodeling , ------------- E Remodeling and/or repairing (describe]_------------------------------------------------------ I - ----------------------------------------- ------------- --- - ------------------------ i . --------------------------------------------------------------------------------.....--------------•---------------------------------------------------- ----------------------------- --------------------------- I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St a laws, and rules and regulations of the San Joaquin Local HeaRk.District. (Signed)---- ------ - :. = {Owner and/or Contractor] B ' -------- - Y• . • - {Title] 5 (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 ' APPLICATION ACCEPTED BY---- --------- ---- -- ��*� ---------------------------------------------- DATE--------J_4' --------------------------- ----------------- REVIEWEDBY----- ----------------------------------------------- --------------._.----"---•--------------- --------•... DATE------ •-------------------------------•------------------- BUILDING PERMIT ISSUED. `= --------------------------------- DATE. �� - ----------.-------------'---------- Alterations and/or recommendations:_. \ �t ------------------- t y. t/ "" = ---------------------------------------- ---------------------------- --------- ------------------------------------------------------ ----- ------- - --------------- . ----- --------- ----------- ----------------- ---------- ................Y_...---__-_...___-....._.____.__.__'____.________.__-______.._____..___.______.._.-_--._--..._.__._____.___-..______..J____.______.__.____.______._________.____- FINAL INSPECTION BY:... ----------- -------------- Date.--- ................... W. v 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 145446 ATWOOD `l\ i +