7272 - Laserfiche WebLink

Home Browse Search

M � r APPLICATION FOR SANITATION PERMIT Permit 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 wo" JOB ADDRESS AND LOCAT . ------fK �- ^ Owner's Name----- Ph one Address------------------ --- •--- ------------------------- ------------------------------------ Contractor's Name x` -•- /rtz ----------------------------------------------•--•------------------------ ------------ Installation ----------Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ r r Number of living units: -------- Number of bedrooms -49— Number of baths I.-_ Lot size Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [] Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No PT"'New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S ptic ank: Distance from nearest wel!__ _ . _, .______________Distance from foundation_____.______._. _.Material__________ ____._--_____-____. �/ No. of compartments--------------------- - Size--------------------------------Liquid depth--------------------------Capacity------- --------------- Dispof�lld: Distance from nearest well_________________Distance from foundation-------.------------Distance to nearest lot line._______•__-_____ A/ II Number of lines-----------------------------------Length of each line-----------------_--------..Width of trench---------------------------- II ------- . ype or i ter material----------------__________Depth of f' aterial___.-------___.f_-___Total length____.___________________________-`____-- Seepage Pit: Distance to nearest welh_ t�eD, rice fr un• n__ . --_-_-.Distance to nearest lot line_____15 Number of pits___..__.__.._._.--Liningrial ` `�--- -- c_.�Siz Diameter : ----Depth---------Z -------•---Cesspool: Distance from nearest well____________ tance from ation.______________---..Lining material-_._____-._.__.___❑ Size: Diameter------------------------- ------- !e ----------------------- -- -----Liquid Capacity---------------------------- Privy: Distance from nearest well---------------_------------__--_--.-.-____...._Distance from nearest building--------------------------------- ❑ Distance to nearest lot line.-------- ----------------------------- Remodeling - -------------------------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, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) ' ��` - -- ------ - -------------- -- ---- (Owner and/or Contractor) BY: (Ti+le)-- 1. �1 ------------------ [Plot plan, showing size of lot, lots ' of-system in re ation to wells, buildings, e+c., can be placed erers side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- ----- ----------------- ---------------•-------- DATE- REVIEWEDBY -- -- ---- ------------------------------------------------------------•--- DATE---------------- BUILDING PERMIT ISSUED ----- ---- - ------------------•---------------------------------------- DATE--------------- -------------- Alterations and/or recommendations------------------- ---- - -- ----------- --- -- �? -- ------- .---- -- ----------------------- ----- - ---------- ------------- ------ --- - - - FINAL INSPECTION BY:------ — p r ----- -------------•------- Date--- -- - ------------------•------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South Arnericen 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 12-5a