7257 - Laserfiche WebLink

Home Browse Search

\4 APPLICATION FOR SANITATION PERMIT Permit No. ____TA—:C (Complete in Duplicate) Date Issued .----3-� -� 4 143 Applica+ion is hereby made to the San Joaquin Loca4 Health District for a permit-f`�s an install th -lork herein described. This application is made// in c//om`pliance �w.ith County Ordinance No. 549. J ____________________________ JOB ADDRESS AN OCATION------`- !?'Il- - - . _ ------ phone.---- ----------------------- Owner's Name-----'it-0/114� - ' Address---------- -------z - --- ---'---- Contractor's Name--- Phone------••----• -------•--------• Installation will serve: Residence El'-A-partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -1..... Number of bedrooms ---3- Number of baths ---/--- Lot size -------!�-----x Water Supply: Public system �91 Community system ❑ Private ❑ Depth to Water Table _ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe) Hardpan ❑ Previous Application Made: Yes ❑ No �ff- New Construction: Yes 2�-No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r Septic Tank: Distance from nearest well �y�UDistance from foundation_.. - Material_ d— ---- _5.6-,V--A-- ---Liquid dep�h-----A'-s-----------.Capacity 91 �o. t T' compartments------- _ ...---'-' Size p tY Disposal Field: Distance from nearest well__/Y& .[distance from foundation______ _ ______Dsstance to nearest lot line .._.___. Number of lines-------------L. Length of each line--- �_0.--._-j,7----.Width of trench.-___1__�_ ________________ Type of filter material__.. _.... - �-Depth of filter material__..,�_.�----._.._--Total length.__.__.__ ______________________ Seepage Pit: Distance to nearest well___d?.v4,Distance from found ation___.�_--------.Distance`f nearest lot line-_-F-�-:-- Number of pits-------.j.___--------Lining material---L�.-�fi�� Diameter------------•-- --'----Deptn_-.-_-_��--_-- Cesspool; Distance from nearest well_________________Distance from foundation- .------__-_____.Lining material_------_.-..__.------------------gals. Size: Diameter---------------------------------------Depth------- -----------------------Liquid Capacity-.-.--------------------_ g Privy: Distance from nearest well...... .....------------------------------------ -Distance from nearest building_______-_--____.-_----------.------------- ❑ Distance to nearest lot line--------- ---------------- ------------------------------------------------------- Remodeling and/or repairing (describe):-- ------- ------------- -----------------•--------------•---------------•-------- ----------------•---------------•----------------------•--------------•----•-------------------------------•---------------•------- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat s, and rules and regulations of the San Joaquin Local Health District. ^ Owner and/or Contractor] (Signed)-------- ---- - - ' r By: - . .........(Ti (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). R DEPARTMENT USE ONLY ACCEPTED BY---- -----------_- ------------ --- --------------------------- ---- DATE ,.,; -------------------------------- APPLICATION REVIEWED BY------------------------------------- ------------- -' - -' - - ---- -- DATE - ----------= j; DATE--------------------------•---.----- ---- BUILDINGPERMIT ISSUED._------'--------'-'-------------- ---'--- --- ----- -----------'----•----------------------------- `�{= --- Alterations and/or recommendations------ - - ------- ...------•----------------------�- ----- ------------------------•-------------•---------- ----�- -- -----•------------- - -------- .. '-'-- ---------- r -- ----- � -- --- ------------------ --------------------- --------------------------- --------------- ---- ------- FINAL INSPECTION BY:.------'- ----------------- --------- - ------ Date------ ------ --------'------- ---------'- -'-------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street no West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ,/S--9-2M 1115446 ATW17100 1Z.-