7508 - Laserfiche WebLink

Home Browse Search

ar� APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued --- _ k :�/_Msry- 41, gA -Disf ricf for a permit to construct and install the work herein described. plica;ion is hereby made to the San Joaquin Local Health >So- 01F0- V2_ This application is made in compliance with County Ordinance No. 549. "JZ0_19B ADID. 6144-JT ----------------------. .....)�--- --- ------ RESS AND LPCATION- . e- ---------- Phone----•------------------------------- Owner's Name---------- -- - - - ----- - ----------------- Z1,_ -------------- ------- Address------------ _-)---------I- - ------- ----------TA-_-4-------------- ------------------ ----------------------------------------------------------------------------------------- . • __.7 ------------------ Phone------------------ Contractor's Name---------------------- ............................... -------I----------------------------------------------- Installation will serve: Residence ❑ partment House 0 Commercial [] Trailer Court El Motel 0 Other 0�u 1:1*e Number of living units- Number of'bedrooms Number of baths ---/__ Lot size ------ --- -------------- - Water Supply: Public system El Community system [] Private X Depth to Water Table,.?--- ft. Character of soil.to a depth of 3 feet: Sand [-] Gravel El Sandy Loam [I Clay Loam E] ClayA Adobe Hardpan E] Previous Application Made: Yes E] Nox New Construction: Yes Ix No El TYPE OF INSTALLATION AND SPECIFICATIONS: + (No septic tank or cesspool permitted if public sewqr is available within 200 feet.) Septic Tank: Distance from nearest well-J."Istan f f undation-----C,9_-5- Mater- - ---- ---- --- -------------- _j, e rop 0 --------- No. of compartments------`7/-------------Size. -----Liquid dep ----------------Capacity...9 Disposal Field: Distance from nearest weI----/Sa.-Distance from foundation-_-J-57....Distance to nearest lot li Number of lines-------- -------------------7 / ' Length of each.line---- Width of tfench_,_,.;9__d�_L------------------ - or Depth length--_--a -0.,49------------------- -- Type filter material- (S--.,.. ep h of filter maler�al------- --------- Seepage Pit: Distance to nearest well----- - --------------Distance from foundation--------------------Distance to nearest lot line----------------- 1-1 Number of pits----------------------Lining material-----------------------Size: Diameter----------------------.Depth-----------------•-------------.- Cesspool: epth------ ------- ------------------ Cesspool: Distance from nearest well-----------------Distance from foundation____-.--..._------- Lining material---------___----..___.-------------- "1 Size: aterial-- ---------------------------------- Size: Diameter----------------- ---------I----------Depth---------------------------- ----------------------Liquid Capacity--------------------------.gals., Privy: Distance from nearest well...........--..............._.__----.------------Distance from nearest building----- ------------------------------------ Distance to nearest lot line...... ---------------- ----------------------------------------- ---------------------------------------------------------------------- ❑ Remodeling and/or repairing (describe):_----. ------ ---- 1�4�---419_4��--- ---- ----------- ----- ------- .. ........ ---------------------------- ----- ----- ... --- --n---- ---- & ----------------I------------— - ----------- �W---- i2 ----------------------------------------------------------------------- ------------------------- ---------- -- - ---------------------------------------------- ----------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Coun ordinances, State laws, and rules and regulations of the San Joaquin Local Health'District. 4 r ------------------------- --------------------- -------- ------[Owner and/or Contractor) (Signed)--- ___ - I ____0 Z&_f-- ---- ---------- ------------- --- By:----- - ---- - ----------------------- - --------------------------------------------(Title)--------- ----------- ------------- ---- ------------------------ (Plot plan showing size of lot, location of system in rotation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY 7. APPLICATION ACCEPTED BY----- ------------------------------- --------- ----- -- ---------------------------------------- DATE----- ------------------------- - - -------------------------------DATE------- - -----5----------------------------------------------- -- REVIEWEDBY----------------------------------- --------- ----- BUILDING PERMIT ISSUED_---__._---.-----_------------- - ------ ------------------------- - - DATE----- --- Alterations ---------- and/or recommendations:--------------- -- --------------- ---------------------------------------------------------I-------------------------------------I-------------------- -- ---------------------------------------- --•-----------------------•---_------------- ------------------------------------------------;Z�p&;� �. ._ 0-- ___/ -7 --------- --------------------- --------------------------------------------_ ---------- ------------------------------------------------------- ----• -------------------------------------------------- - .-- ----------------- ------------ ------------------------------ ----- --- -------------------------------------- -------------------------- --------------------------------------------------------------- ------------ -------------------- ---------------- - ------------------------------------------------------------------------ Date-------------------- ---------------------- FINAL INSPECTION BY------ ------- ------- -------- ---------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street inSycamore Street $14 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California r!;-9-2 M 14S446 ATWOOD 12-54