7028 - Laserfiche WebLink

Home Browse Search

kAPPLICATION FOR SANITATION PERMIT Permit 7N6. No. (Complete in Duplicate} \, - ----------------- Date lssue�..---11 Sra This is hereby made to the San Joaquin Local Health District for a permit to construct an is application is made in compliance with County Ordinance No. 549 d install the work here-described. JOB ADDRESS AND CATION.'___- ------- -- Owner's Nome,---. - - ------------------------------------------------ ---- - K�Iv!--------- -------- j ------ ---------- -- ----------------- ------- --------- -- ----------------------------- ----------- Phone-------------------- -Address -------- --------- ----�:-------------------- -------------------- Contractor's Name. --------------------------------------I---------------------------- ------7q-- ----------- -------------------------------------------- Phone Installation will serve: Residence ffj�Apartmerif House E3 Comm I erc;al E3 Trailer Court 0 Motel 0 Other 0 Number of living units: --/---- Number of bedrooms -----^;;-'-Number ❑ of baths Wafer Supply: Public system 0- Co.mmunify sy' ---/--- Lot size ja--p----------------------- stem 0 Private [I Depth to Water Table .410r—ft. Character of soil to a depth of 3 fOef: Sand C1 Gravel [] Sandy Loam E] Clay Loam E] Clay El Adobe Hardpan 0 Previous Application Made: Yes E] ❑ I No 21, New Construction: Yes El 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 4 �-QlLr--Disfance from foundation--" Material a e- No. of compartmpents ---------------- ----------- ------Size6.--Z--XS-6-----Liquid depjh......(0e ------ Disposal Field: Distance from nearest / �r -------- Ca pacity------I" arest well-,-V-02.0-1)isfa nce from foundation,----- -40 Number,of lines--;---j --___--_-Distance to nearest lot line----- - ----- ---j--------------Length of each line it . ...... Type of�filfer material-Za----,!�7 -------- 04 line--------- -C>-__--------Width of trench _Depth of filter ma.terial----/-'13------------Total length------ Seepage Pit: Distance to nearest well-./l/4- !!;:-7.0-2 RNumber of pifs. >,-L----Disfance from foundation_- to nearest lot line---,-- Cesspool: Diameter— ----Dept --/--------------Lining mate ria)--e-4�19 Distance from nearest well-----------------Distance from foundation .............. Size' Diameter` ----------- -----Depth l------------ - -------------------Lining material- ------------- ........... �j 7-------------------- ------- ---Liquid Capacity---------------------- -------- Privy: Distance from nearest well - -gals, ❑ Distance to nearest lot line__------------------------------ Distance from nearest building--------------_-_ -_----- --------I-------- .I ------------------------------------------------------------- --------------------- ------------------------- Remodeling and/or repairing (describe)___________________ p . ----------------I------------------------------------------------------ -------•-- ----------------------- ---------------------- ---------------------------------------------------------------------------------------------I---------------------------------------------- -------------------------------------------------- ------------------------------------- F ----------- ------------------------7------------------ ------•--------------------------- --------------I------------------------------------------------------------------------------------- -------•----------------------------- ----------------------------- ------------------------------------- - 0 1 hereby certify that I have prepared this application and that the work will be doncf n*----c with San Joaquin County ordinances, State ws, and rules and regulations of the San Joaquin Local Health District. (Signed)-.. ------------------------- -----------------------------------------------------------------------------------------------------(Owner and/or Con rac o By.-... ---- ----- ----- -- --------- f f r) (Plot plan, showing s f (Title)------ ----- ---- ---- ------- - size of lot, location of system in relation to wells, be placed --------------------------------------- on reverse side). APPLICATION ACCEPTED BY--.-.-------- ---- ----- - ----------------- ------------------------------------------- DATE_ <- ----------- REVIEWED BY BUILDING PERMIT ISSUED ----------------------- ------ ------ - - - -------------------------------------------------------------- ----- DATE- ----------------------------- DATE - -Alterations and/or recommendations:------ -- ----- a , -- - ---- --••- ----------------------------------------------- --------- - \3 ------ --- ------- - ---- --- ---- ------!c--------------------------- ----------------- --------- ------:-------------------------- ------------------------------------------------- ------- --------------------I...... ------- ------- -------------------------------------------------------I------- --------------- ----------11----- -------- ---------------------- ......... -------- --------I----------------------------- --------I------- -------------------------- --------------------------------------------------------- -------------------------------------------------------------------------------- -------- ---------- ----- - ---------------- FINAL INSPECTION ------------------------- - ----------------------------- ------ Date----- -------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Soufh American Street 300 West Oak Street 132 Sycamore Street 814 North'"C" Street Stockton, California Lodi, California Manteca, California Tracy, California 145446 ATWOoD 12-54