5173 - Laserfiche WebLink

Home Browse Search

S173 APPLICATION FOR SANITATION PERMIT Permit No.'�S__ (Complete in Duplicate) s ,�- Date Issued yS' 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. 544. Wilkerson Manor -_ _E1�-- e 30-- 06 JOB ADDRESS AND LOCATION Lot 1 ------- ------- ---- -- --- --------------------------- Owner's - - ---- Owner's Name--------------Floyd & Wilkerson Phone Address-•---------------•-------s------------------------------------------------------------------------- Contractor's Name..............AboVePhone --------------------------------------------------------------------------------------------:---- 1 Installation will serve: f Residence Apartment House ❑ Commercial ❑ Trailer Court .❑ Motel [] Other 171. Number of living units: ---t__ Number of bedrooms ____Number of baths ___�___ Lot size ____ ___----- ___ ----------------------- 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 ❑ Clay Loam ❑ Clay 0 Adobell�Harcipan p Previous Application Made: Yes ❑ New Construction: Yes (�o ❑ 1 TYPE'OF INSTALLATION AND SPECIFICATIONS: r (No septic tank or cesspool permitted if public sewer is available within 200 feet.) j Septic •ank: Distance from nearest well-----""__-PDistance from foundation_ _. Material ._ -� --------- efNo. of compartments________ �_.-.___Sizu .. -- - . .___Liquid e _.____ .';.:________Capacity -- - ,_� Disposal Field: Distance from nearest well-------"._____Distance from foundation___ _ _ ________Distance to nearest lot Number of lines------------ -- ---- --`--.____-- h g f �Q_ ^_ _d_.Width of trench-------21_-------- _-_--- Type of filter materia __Depthaffilter� }material____�"_ ____________Total length______ ------------------ Seepage Pit: Distance to nearest well______________________Distance from foundation....................Distance to nearest lot line................. tC ❑ Number of pits------- -----------Lining material----------.------------Size: Diameter---------------------- Depth--------------------------------- Cesspool- -----------.-------------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------------------------.._._ - C� ❑ Distance to nearest lot line--------------------------------------'----------------------------------------------------------------------------------•-•-------------------- Remodeling and/or repairing fdescribe)______________________ _ --------------------------------------------------------------------------------------------------------------------------------------------------------=---- ------------------•---------------•------------------------ R --------------•---------------------- ------------------•--------------------------------------F-------• -----... ----------------------------------------------------------------------------------------------------------- I hereby certify that Iave prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State Ws, a d;Oes. R'd regulations of. the San'Joaquin Local Health District. - .r (Signed)....---- ----- ----- --- ------- . -,•-- ---=--------- ---------------------------------------------------------------------------(Owner and/or Contractor) By:------------------------- ..........---------------r------------- ------------------------- ---------------------------------.._(Title)---------------------------------------------------------------- (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 V" APPLICATION ACCEPTED BY-------- -- -------------- ----- ------------------------------------------------------------ DAT -- ----•----------------------------- - -- -------------- REVIEWED BY - - 1 D --------�-----------------------••----•-------- BUILDING PERMIT ISSUED D E---------------------------------------- Alterations and/or recommendations:-------- ---•- -.-11--_--------- ------------ ------------------------------------------..----------------------•--------------------------------------- ,. -------•-----------------------------------------------•-----------------------------------------------------------------------------------------•----------------•-•-------------------------------------------------------- ----------------------------------------------------•----------------------------------------------I——-------------------------------------------------•---`--------------------------------------------------------- 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---4-2M • Revised W-2100