8865 - Laserfiche WebLink

Home Browse Search

S� \ APPLICATION FOR SANITATION PERMIT Permit No. .. ................... (Complete im,Duplicate) l Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to conruct and install the_work herein described. This application is made in compliance with County Ordinance No. 549. p JOB ADDRESS AND LOppCATIOrN ------ .? � )��--°---------------5.. 1----"y'` ------------ '..------------------------................. Owner's Name......../-�'-t--l=�---------1'2.S)- -4d---------Ll..l__�.1„4-1_.��'�IS. --------------�-- ------ Phone. ----------------777777 77-7777-- Address---------• ---�.,� . •-------•• --------. .�V..----------•--------------------------------------------•-------......1........-•---................... Contractor's Name---- - ,......---------------__--------------------------------------------- Phone................................... Installation will serve: Residence ❑ Apartment House & Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __3__ Number of bedrooms ._ 3 ,_.. Number of baths _ Lot size _-- !� -•-.- -,� --------------------- Water Supply: Public system 2--c"ommunity system ❑ Private ❑ Depth to Water Table __s Oft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam ❑ Clay ❑ AdobeQL Hardpan El Previous Application Made: Yes ❑ No P_ New Construction: Yes Z. No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t Septic Tank: Distance from nearest well_,_. _distance from foundatiof._. ----------Material_ �_ •tl " Is No. of compartments-___. -_.�------------Size---671---X ,0!Aquid depth_.___p ---------Capacity----- --6:f7 D__-,ti_ I Disp�sal Field: Distance from nearest _ _ well- from foundation......A*- _ __-- .Distance to nearest lot line .41 I Number of lines.. ----- of each line_____ Q__ 1dth of trench_____ .� Type of filter material----/S_1_-_�.AQDepth of filter material_.... `_._.Total length___./. 0 ----.---------- � Seepage Pit: Distance to nearest well....Mo-uUistance fQm foundation-------,..........Distance tp nearest lot line .4 fG Number of pits------ ----- __Lining material---r,� v_4_�<Size: Diameter___-.�_-_______Depth-- -_�----_........... "V Cesspool: Distance from nearest well________________Distance from foundation..... __. Linroatexial__--------------- 1777------------ Size: - Size: Diameter--------------------------- -----Depth------------ -- -•----- ------ --- --------Liquid Capacity gals Privy: Distance from nearest well __-- -- -- --------- -------------Distance from nearest building----------------------------------------- F1 Distance to nearest lot line- :--f - --- ------- ------------- •---------•-----•• -----•• -- •-•--------------- ------- -- ................ l Remodeling and/or repairing (describe)------- --------_-----_•-•--•••--•------•......•--•.....--•----•--•--•- -=------ -----••. -•- •-• -•-•----- --------------------------------- ----------'•--------------------------------------------------------=-----------•--------------------------------------------------------------------.............. -------------------•-- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, ;at s, and rules and regulations of the San Joaquin Local Health District. Owner an or Contractor 7+777."""". ( ), , (Signed)--7777-- 777--�. = .. .-- - 7777-�-°-�'��"'�""� - - ---7777-- BY• ----------------------------------(Title)------ -- ---- -•--h------------ ---------------------- (Plot plan, showing size of lot, location of system.in.relation to wells, buildings, etc., can be placed on rev se side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----.--------------------- ------_----------------- ---- -- DATE......._.._ ,,'r _______.__ REVIEWEDBY------------ -------- ------------------ -------------------------------------------------------- ------ DATE----------- BUILDING PERMIT ISSUED................. - -- -------------- - --•-- ---------------------------- DATE.... . ......................... .... ,:----------- ---- Alterations and/or recommendations-- --- ----------_---- ----------------------- ...----••------••---- -----------------............................. ---- 7777-- ---A.... --- ------- --------- -rn . .......:............--------- ......-•------- - --- ---- ------- \ -----; ----- ,/t., F NAL INSPECTION BY:.... __-_._-_ Date....__.. . 1117___ [_ �!/ _ SAN JOA UIN LOCAL HEALTH DISTRI 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-3 145446 ATWOOD A