7710 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT —Perm it No. ": (Complete in Duplicate) � ��•.��' Date Issued 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 LOCATION-- -a-"4 -----.c ... .............. ---- A- -----------•-----•---------------- Owner's Name.-- -tom'"-- Phone. Address--------- �� .1 _..:f_.:ri as i ' ------•---•--••--------•-- Contractor's Name-- ----- --=--------------- ----------------------------------------- '7Fhone----------------------------------- Installation ------------------------ ---- ---Installation will serve: Residence ZApartment House ] Commercial ❑ Trailer Court ❑ Motel [❑ Ot er ❑ %A Number of livingunits. ____-___ Number of bedrooms ______._ Number of baths __-.--- Lot size ___. .--__ __�_ __ _ __ - _ is Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. - Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Lo;PNO Clay Loam [I Clay E] Adobe �ardpan ❑ Previous Application Made: Yes E] N6 LTJ11' New Construction: Yes ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: l (No septic tank or cesspool permitted if public sewer is available within 200 feet.)f Septic Tank: Distance from nearest we-ll--, --Distance from round?ti�n Material No. of compartments------ --- - ---Size- ©?-_�-- Liquid th_ ------------ -- Ca Paci�Y � �(1__ .-- Disposal Field- Distance nearest well_________________Distance from foundation--------------------Distance to nearest lot line___--_-_-________ ❑ Number of lines-----------------------------------Length of each line------------------------------Width oftrench-----------:_------------- ---_---- Type of filter material_________________________Depth of filter material-----------------------Total length------..---____________.______-________._ Seepage Pit: Distance to nearest well____________________ Distance fromyfoundat:on__...___--- _____.Distance to nearest lot line---____.___.__._- [� Number of pits----------------------Lining material--.-----.f --'-Size: Diameter,-.--------------------Depth---_----------------------------- e Cesspool: Distance from nearest well----------------- from foundation--------------------Lining material__-.____.___..._____________________ Size: Diameter----------------- -----.De Depth--- .-------------Li Liquid Ca pacify-, ----------._gals, ❑ p q P Y 9 Privy: Distance from nearest well------------_____________._._____ ______{_Distance from nearest building------------------------------------------- s ❑ Distance to nearest lot line . ------ --------- ------------- I -----•--------- -----------------------------------------------------------'------------ -- Remod6ling nd/or repairing des ribe):- '---------••------ L - --------- --. .. 't : -tt-r . _ -' ---�_��!,P,�..iA.� wf:Ei�a 0------------------------U-------------------------------•---- -•-•--------...----- .__-----•------ --•------------------------------------------ ------- ---- ------ ------ --------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------- I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County. ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) ----------------------------- ----------------------------------------------- =----- - - ----.(Owner and/or Contractor) �7T By:• ,,�: -- ��'Xt - -------------------------------------------------------------(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 APPLICATION ACCEPTED BY,�_ ... DATEEZ�--- - ------ -- ----- • REVIEWED BY - •---------------------------- DATE--�*1---------------------------------------------------- BUILDING ------- ----• - BIJILDING PERMIT ISSUED ,'--- DATE -4 Alterationsand/or recommendations--------------- -- -----------------------------------------------------------------------------------•---Z------------------------------------•------._.. -----------------------•-----------•----- -----•------------------------------------------------------------------------------------------------------------------------------------------ ----------------------------------- - ----------------------------------------------------------------- ----------------------•------------------------------•----------------------------.-.-.------------------------------•-------------....:-----•--- ---------------------------------------------------- ----------------------------------------------------------- ---------------------------------•-------•------------------------------------------------------------------ FINAL INSPECTION BY:.. - -- �1� ->�r- ---.�G �S 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 ;45446 ATWOOD ~