7022 - Laserfiche WebLink

Home Browse Search

'1 APPLICATION FOR SANITATION PERMIT Permit No. .. o- .v a (Complete in Duplicate] Date Issued V� _/.r�_"'_�`�__�S�• PAp�rplica*ion is hereby made to the San Joaquin Local Health District for a permit to construct and install lthe work herein described. This application is made in compliance with County Ordinance No. 549. -Ar1r) JOB ADDRESS AND LOCATION-------------------`�.lap ------------5?------ f=1 .fN -------------- = ------StI-� --------� •-•------- -------------- ------ Phone------------------------------------ Owner's Name ----•----------------- ------------ ' Address-------------------------------------------------------------------------------------------------- - ' ''°Q--:.._--------------------------------------------------- --------- -__ Phone.---------__.-_-------=.---------- Contractor's Name------------------------------------------------------ - 'Installation will serve: Residence x Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ i Number of living units: _ --- Number of bedrooms-_-- Number of baths -8-_ Lot size _ __--x... ___------------------._..._-___-_ Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table -------- ft. d Character of soil to a depth of 3 feet: a Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ 4 TYPE OF INSTALLATION AND SPECIFICATIONS:- "J (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation---------------- Material_-.___.______-_________----._____..___--_____. ❑ No. of compartments---- -- - - -----------Size--------------------------------Liquid depth.-------------- -------.-Capacity------------------------ l Disposal Field: Distance from nearest well-----------------Distance from foundation-------------------.Distance to nearest lot line-________________ ❑ Number of lines-----------------------------------Length of each line---------------------------_-.Width of trench----------------------------------- ; Type of,filter material------------------:------Depth of filter material.....------------`----Total length-----------------.-------------- -----`.. Seepage Pit: Distance to nearest well....... ------.Distance from f undation______-j�-fi.Distance to nearest lot line_-ass-------- J Number of pits---------I-----------Lining material----> �_ c/_----Size:•Diameter.---3X.(a---------Depth--------t--0----------------- � Cesspool: Distance fi-om nearest well________________Distance from foundation._..__-___--____-.Lining material,..__.____._____._..----________--_ ❑ Size: Diameter-----------------------r--------------Depth--------------------------------------------------.-Liquid Capacity---------------------------gals. Privy: Distance from nearest well------ ------------------------.____.._.----------Distance from nearest building------------------------------.----------- ----------------------Distance to nearest lot line--------- ------------- - Remodeling and/or repairing (describe):-_-------------- --------------------------------•-------------------•--•------------------• .--•-----•-- ---------------------------------- ------- ------------ ---------- ------------- -------------------------------------------------------------------- ------------------------ --------------------------•----------------••--------�---- rob certif that I have prepared this application and that the work will be done in accordance with San Joaquin Cou )� 1 he'rob ordinances, Stat ws, and rules and regulations of the San Joaquin Local Health District. ---------- (Signed) ----------- ---------------------------------------(Owner and/or Contractor) --- ----- -- -- - -- -------- - - --- -- ------------------------------------------------------------------------------------(Tit e)-- - (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 DATE---------•--!rp. APPLICATION ACCEPTED BY------------ - ------------ --------- --- --------- � r REVIEWED BY------------------------------------------- - ---------- ------------ ----------------- DATE --------/p'---•-• ---- -------- - ------------- BUILDINGPERMIT ISSUED---------------------------------------- ----------------------------------- DATE------------------------------------------------ Alterations ------------------------------------ ---------Alterations and/or recommendations---------------------- -------------- ---- ------------•------ --------------------------- - r Jr a f ---------- �---- - f ---•-- ---- ----------------•----•---------- ---------•------- - ---------------- ---------------------- - i - ----------------------------- - --------------------------------------------------•------•-------------- ----- ----------- - 1 FINAL INSPECTION BY-------- -- ------------ --- -----•------ ------ Date._.... -�.-- -�--- 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