6683 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. • /,4-/y (Complete in Duplicate) Date Issued ..y1.71r. 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_. __ 4- � Owner's Name ------- 'E'er------ 4:_ 1cLS._Q-�VI4------- ------------------------ --------- Phone--------------------gu:�77� ------------------ Contractor's Name -------- ---------- Phone ► Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __(-___- Number of bedrooms _74-Number of baths ----1_ Lot size ------------b13 Water Supply: Public system ❑' 'Community system ❑ Private �pth to Water Table ________ ft- Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ $7 Previous Application Made: Yes ❑ No ��e_w Construction: Yes E4--tqo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: {No septic tank or.cesspool permitted.if public sewer is available within 200 feet.) l Septic Tank: Distance from nearest well_-.4-0_ --- Distance from foundation/4- ----__.MateriaL4 , [- compartments No. of com _._. . P ' ' Size _Y, _.Liquid e th ' --------Capacity.. - Disposal Field: Distance from nearest well.... Distance from foundation .__. ( ____Distance to nearest lot linef____... ` Number of lines------------_�_._ -__ Len Length of each line______'___ � ' � l 9 /}.. ........Width.of french---------- -1l-- ------------- Type of filter mate ria l-i°j ---,-Depth of filter material___ ........Total length__ _________ �., --------------------- Seepage Pit: _ Distance to nearest well_..__...__-__._`_&-----Distance from foundation-------------_------Distance to nearest lot line--------- ❑ Number of pits-------------- -------Lining 'material------ -------------...Size: Diameter----------------- - ---Depth ..... -------- --------____ ----.___ Cesspool: Distance from nearest well_________________Distance from foundation__.._.----_._...._ Lining material--------._-_-.______________ ❑ Size: Diameter------------- -------------------------Depth-------------- Liquid Capacity------------------------- gals. Privfrom . !.. -.. .- y Distance nearest well ______________ --------------Distance from nearest building - ❑ Distance to nearest lot line 4 Remodeling and/or*repairing (clescr;be)_-------------- ---__---____._._ -------------- 1 ------------------------- ______{__� ______________________________ . ---------------------------------------------------------__________ i i ---------------------------------------------.--------------------------,--------.--------------------------------------------------------------------------- --------------------------------------------------------------- I 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. ) Si ned v g ------------------------------------------------------:----------- ------ ------------------------------------------------- --------------(Owner and/or Contractor) Plot Ian, s1----•-•---• --------------------•-------------------•-------------------.-:----- --------.-.----------------- ----- B�•---- - (Title)------------------ ------------- ----- -- - , ( p owing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side)--------------------------- FOR _ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------------------------- DATE------.------ REVIEWEDBY-------------------------------------- ----------------------------------------- --------- DATE--------- ------- - -------------- BUILDING PERMIT ISSUED ------------------------------------------------- ------------ ------------------- DATE---------------- Alterations and/or recommendations_____________________________ -------------- ---------------------------;--•-----------•------------------ --------------------------------------------------------`------------ --------••------------------- -------------•----------- ---------------------------•--- FINAL INSPECTION BY:--------� __.------.- ----- ------------'---------- • Date------- SAN -�-�---'--�- -'- ----------' 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 E-'-+'-4-2M 145446 ATWOOD 12'54 f