7998 - Laserfiche WebLink

Home Browse Search

SIP V APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued lli1/z._. 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. JOB ADDRESS AND LO TIO __.._1----/-- A- <3tJ Owner's Name •--•-- ----------------------------------------------------- Phone.................................... Address ---- -------•-o •••• ',�7?.'1K .3e.+e------.. Contractor's Name__________ ____ --------- -------••-- -�_ / ----------------- Phone._-_-- -�- ...y = Installation will serve: Residence;�Apartment House E] Commercial E] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ._..__-_ Number of bedrooms -__Number of baths -------- Lot Lot size __. '.?�_..._,� •.1 .. .-__.- Water Supply: Public system 2r.1c"ommunity system ❑ Private ❑ Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0--,Hardpan ❑ Previous Application Made: Yes ❑ No [BOO; New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Distance from nearest well--.-.----- -------Distance from foundation--------------------Material------------------.--_.---_--___._-_.-_----_.-__. No. of compartments--------------------------Size----------------------------•---Liquid depth-------------------------Capacity----------------------- sal Id,;,— 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 er material--------------.--------Total length----------------_. _---___-__.----___-- Seepage Pi Distance to nearest /wel-.Y. -_O_ ._.___._Distance undation___ _ __•___._.Distance to nearest lot linei__ . . v Number of pits... m - Y _.._.Size: Diameter_ Q--------.-----Dept -- _ __..___.__ __.__ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material.-:---_--_.-____-----__---_----_--__-. ❑ Size: Diameter-------------------------- ----------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------_-------__--------------------------------Distance from nearest building---------_........................_....... ❑ Distance to nearest lot line---------------------------------------------- .......................------------------•-•-----•------------------------------•-----------• �. Remodeling and/or repairing (describe)-------------------------------•................................................... ••----••----------------- ...................................... �l ---------------------------------------------------------------------------------•---•---------------------------------••------------------------..............................-_--------------- --------- -------- ----------------------------------- ----- ----------------------------------•----•---••--••--------------•-••-------------------•-------•------•---•••---- ---------•-------•-•-••-•--•-•---------------------- -------- I hereby certify that I have prepared this application and that the work will be done in accords a with San Joaquin County ordinances, State laws, and ruLipi pS lat�ns of the San Joa uin Local Health District. (Signed)..... Septic Tank fSVeFFrllvice -----_ r Contractor 14db So.IEliToracTo---HO-2=7046----------- - +fit. ) By:---- ......•-•---Stockton,.calif_------------------------ -- ---- - -------------- ------------(Title)---------------------------------------------- ---------------- (Piot plan, showing size of lot, location of system in relation wells, buildings, tc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------ - DATE-------- `. REVIEWEDBY------------------------------------- --------------------------------------------------------- DATE----------- ---_ ........................ BUILDING PERMIT ISSUED......................... --- ----------------------------------------------- ------ DATE-------------------------------------------- Alterations and/or recommen tions---------------------- -------- - .-- --------- -------- _.-- ✓ .� -- --------------------- FINAL INSPECTION BY----- -------- ----- --------------------------- -Date------------ .............../ .- `� ! ................ SAIN'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