7256 - Laserfiche WebLink

Home Browse Search

7 -s-6 APPLICATION FOR SANITATION PERMIT permit No. .____...__ (Complete in Duplicate) 31 --•�f 3 pate Issued ----------- _-;� T pplica;ion is hereby made to the San Joaquin Local Health District for a permi c nst ct v install�th work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND �OCATION_-•----- 1 = = �`�f 1 ---------- o9 � - ta,3�� Owner's Name---------- ----------------------------------------- Phone------------------------------------ ---------------------------------------------------------------------- --------------------•--.-----.---------.---------------•- --_---- ----------------------------- Address ----------- .........�------- Contractor's Name._----_- --- ---------------- Phone Installation will serve. Residence artment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ . � P ` Number of living units: _j----- Number of bedrooms _ `�__ Number of baths ---I _- Lot size -------/-` ----> --1- -------------- ---- Water Supply: Public system [Community'system ❑ Private ❑ Depth to Water Table rJt. Character of soil to a depth of 3 feet: -:Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe gg�,Hardpan ❑, Previous Application Made: Yes ❑ No iZ. New Construction: Yes;K_No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-_>I�� -Distance from foundation-----I_c---------Material----- ------ �� No. of compartments----- / - Size 7.:. Liquid dep`h---- .. ..----------Capacity------tP-��------ Q Disposal Field: Distance from nearest well.__/14P':i4,Distance from foundation-___--- .._-..-Distance to nearest lot line----- _�. �r Number of lines------------/---- __ _Length of each line------'�e--------------Width of trench.--------" _�F--------------- �r n f �f---Total length----------of filter material_-_jam ..� .r Depth of filter material-.-.--- -.- _t J Seepage Pit: Distance to nearest well---- Distance from foundation_--.4-10-------Distanc�e�o nearest lot Number of.of its..-- --- / Lining material- Pi 4S& Diameter----_�. --___--Deptn__----�C9---------------- RL 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---------------- --------- Rem aeling and/or repairing (describe):----------------;---------- - -------------•------------•-----------•----••---------•--:------------•------•----------------- ------------ ---------------------------- •-----------------------------•----------•-------•-------------------------- -------- ------------------------ ---------------- ---------•-----••------•---------------- ! hereby 'if that I have-prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S ate I ws, and rules and regulations of the San Joaquin Local Health District. (Signedl - -,r .---- ------------------ I ner and/or Contractor) By:...- --- -------- � --- - •----------------------- (Title)---- � - --------•------------------------------------ (Plot plan, s owing 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 ---------- DATE-------------------------PERMIT ISSUED---------------------------- ---- ---- -- --•- Alterations and/or recommendations-------- - - --------------------------- -----•-------------------------------- ----- -------••----------- ------------- - ----- B 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 E5-9-2M 145446 ATWOOD 12.54