7990 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. ` (Complete in Duplicate) �//] Date Issued _717-4& 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--------- - EIK - /77_4 ----------------------------------•--- Owner's Name---------------- ---------- ----------- --------- Phone--------------------------------.--- Address...... �` ��A - .. --------------------------------------------------------------------------------------------------------------- --- - Contractor's Name..................... "A--- ---•------ --------------------------------------------------------••-•--------------- Phone --- ---•-----•--- Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other ❑ Number of living units: 4f_'____ Number of bedrooms _ Number of baths ----/---- Lot size, -,___ f�. - --`---------------- Water Supply: Public system El Community system E] Private ❑ Depth to Water Tableft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No Or New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) .-Sept' Tank: Distance from nearest well................Distance from foundation--------------------Material------------------------------------------------- 4e, 'r! No. of compartments---------- ---------------Size--------------------------------Liquid depth---------------- ---------Capacity----------------------- ispo b) Field: Distance from nearest well-----------------Distance from foundation------------.------.Distance to nearest lot line--------_-------. Number of lines------------------------------ --Length of each line------------------------------Width of french-------------:--------------------- Type of filter material.------------------------Depth of filter material--------.--------------Total length_-_------_---_-__-_--_____-__-___-_-:---_ Seepage Pit:, -, Distance to nearest well_.i __ ____________Distance from found tion___._-•..._...-.SQi ance to nearest lot line___:='____._____ 14,4 Number of pits------`__________.Lining material_I�_�.`.�-f'>_"f•:�r ize: Diameter_ -g --- ---- - . Depth------ _fi________________ esspool: Distance from nearest well----------------Distance from foundation....................Lining material-----------------._ ------._--_______ ❑ Size: Diameter-------- -----------------------------Deth----------------------------------- ------------ ---Liquid Capacity gals. Privy: Distance from nearest well-------------------------------------------_.-Distance from nearest building----.-----.--.---_-__-_---_-.------_-----. Distanceto nearest lot line--------- ------------------ •-- -------------------------••-----f•---------------- --------------------------------•----------------------- em eling and/or repairing (describe) -ry"`c.E �rte .--------••----•------------ •(b -'---------rQ-XJ- ------T. 'I`!+'1 _T-..----•------•------------------------------------------------------------------- ---------------------------------------------------------•-------------------------... ---•------------------------------------------------------------------------------------.--------------------------------- -------------------------------------------------------------------------------------------------- ------------------------------------------------------•-•--- -------------------•-------------- -------------------------- 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. (Signed)------------------- t 4 - ------------AfT7-�'t'4 n -- --------{«we"mWor Contractor) ------!V---------------------------------- r11156 -�-, ! B 15 ------------------- -----------------(Title)------`�2 �7= _. _:• !`. Y:-- ----•-- ------ - ---- (Plot plan, showing size of lot,�� a+ion of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY-- ------------------------- ------------- --------------------------------------------------- DATE- --------------------------------------------------- BYDATE�----------------------- ----------------------•--- BUILDING PERMIT ISSUED.------ ---�------ --------------- --------------------------------- ------ DATE-• ��,. ---------------------- Alterationsand/orc mmendafions------------- ----------- - -------------------------•-------------------•--•- ---------------•-----•--------•---•-------------•----•---- •--••- -------- - --------/I- / -------------------------------•-------•------------------ ----------------------------------------------------------------------------------------------------------------•------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY: = �y`�-`-- ---------- ------------- Date �=--1 ---- ----------------- 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-9-2M 14S446 ATWOOD 12-54 v