6998 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. �--�. .... (Complete in Duplicate) Date Issued 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 Count Ordinanc No. 549. N ----------- - iJOB ADDRESS AND LOCA�i Owner's Name------------------ A --------------- ------ ------- � -------------- -r�-�--- --:-:: Phone------------------------------------ -------------------- ---`--- ---- Address---- -------------- - ----7---- - ------------------------ Contractor's ------------ ---- Contractor's Name--------- ----- -- ----- - --- - ---- - -- -- Phone- - D.^-ff�-�-�f� Installation will serve: Resident rr Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑] rOther Number of living units: --.1- ber of bedrooms 4-- Number of baths I---- Lot size ._._-�Q._/1--1�� 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 ❑ ay Loam ❑ Clay ❑ AdobeHardpan-EjII Previous Application Made: Yes E] N0 .New Construction: Yes to ❑ TYPE OF INSTALLATION AND SPE61FICATIONS: (No septic tank or cesspool permitted if�public - ssever is available within 200 feet.) I I Septic Tan Distance from nearest wel<rja-.C&Y-Distance from foundation--.-ll�--�_-_-_Material------------------------------------------- No. ----- - ! No.�of compartments .i— ---------------- ze_- '6--- ��-- Liquid depth----- Zr-----..Ca capacity--.. . ._ y `� i r � f - p Y ,�------� , Disposal Fi Distance from neatest well____. -. -Distance from foundation_--. -5 -----.Distance to nearest lotne_1 -...-.-.. __"` Length of each line-_-Jt- ------------------- -Width of trench._.-.-------------------------- Type' ------------------------ > Number o{ lines`_ -:-___-_ _-_. T e' or filter materialta_ _. .--- ---. Depth of filter material----.SC-sr-....--.Total length-------- Q_`-------------------- -- Seepage Pi Distance to nearest well----------------------Dista e fro u tion---f__15----------Distance to nearest lot line--/d Number of pits__1�'j -r ...--Lining materi I_e------------- ----Si e: Dia meter-- - --__-----Depth------- .0--_- ------------ Cesspool: Distance from nearest well-----.---- Distan .fo ation....................Lining material--.-.---- .------ _----- ❑ Size! Diameter---------- ----`--------------------Depth------------------------------------ ------- --------Liquid Capacity. . •-•-•-------.....------.gals. Privy: Distance from rearest well ----___------------------------- --------------Distance from nearest building.----_ _-.._-----_--___-__-------.---. ❑ Distance to nearest lot line.,. - ------------------------- ----------- --------- ------- " 7 ------------- -•------------------ Remodeling and/or repairing (describe)---------- ------ ---- -- ------ ------ -- ------- ----------------- -------------------------------------------------------- ---- ---- -- - -- - -- ----- -----------------------------------------------•-•-----•---------------------------------------------------- ------------------------------------------------------------------------------------------------- I hereby certify tha+ I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State s, nd rules and regula ' ns of the n�Joaquiirt Local alth District. (Signed)------- ---- ----(S'r-- �-� (Owner and/or Contractor) -------- By:------------- ---- =`---� - - ---- ----•----------- (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 --------------------------------------- REVIEWEDBY------------------------ -------------------------------------------------------------------------- ----- DATE ---------------•-•---••----------•------- BUILDINGPERMIT ISSUED——----------------------------------------------------------------------------------------------- DATE-----------a\-------------------------------------------- Alt re ations and/or recommendations:-Al /'J-- - n r =0----------- A7------el ` --------------------- --------- ----------- '� if -' -------------------'�- ---- --- = x.: � t �8 --------- ---------- ------------------------------- FINAL INSPECTION BY------------------------------------------ --------------•----- Date--- ----------------------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Stieet 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2M 149446 ATWOOD 12-54 _