8173 - Laserfiche WebLink

Home Browse Search

✓ { APPLICATION FOR SANITATION PERMIT Permit No. __P73 (Complete in Duplicate) Date Issued ,. Applica+ion is hereby made to the San Joaquin Local Health District for permit to construct and install the work herein described. This application is made in compliance with County Ordin nce No. 549. ,JOB ADDRESS AND LOCATION __` ��- _ - •----..-..-. --------- - . Owner's Name---------- I ...----- � �. Phone �,, ,fir yr Address-----'-----��e---------- - `�---`-=7XV-4l Contractors Name--------------- _____ _ __:�....... r, - ... Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -4---- Number of bedrooms _ ._ Number of baths J.._ Lot size ._..-- - -- ..---------------------- Ll Water Supply: Public system Community system [IPrivate ❑" Depth to Water Table ,W-"ft. .f Character of soil to a depth of 3 feet: Sand'❑ Gravel ❑. Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [!j;-_Rerdpan ❑ Previous Application Made: Yes ❑ -No 5�f' New Construction: Yes & No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: $ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f Septic Tank: Distance from nearest weIlFr_Distance from f,undation__. Cr'__._______.Mate�a�-__ - _:-_ _______ _____________ i Size----_ ..49--A__- _�----Liquid depth.-._�(7- capacity___- - _- No. of compartments '2---------- ` 9� _ 0 ._....---Distance to nearest lot lind"'A:�.._ d DisposalField: Distance from nearest well-A C4,_Distance from*foundation__ . 1 IJ Number of lines_-_-_---1.............. :.. Length of each line--_. e u { �!--�� ---------- -Width of trench----- --- ---------------- Type of filter material/J.-- _ -__Depth of filter ma#erial___ _ ___________Total length------ _0`-_,._____--_-__-_....._ � � � �l Seepa Pit: Distance to nearest well_-_-� z --Distance from foun tion-_ -�-...__---.Distance to nearest to line_______________,- Number of pits.-.----/------------Lining' mater.ial_C_e_& ize: Diameter_ _ -------- p ' --------------- De to r w Cesspool: Distance from nearest well-----------------Distance from foundation.:...............--- Lining material-------------------------------------- l k ElSize: Diameter-------- ----------Depth-------------------•------- -------- ------ --------Liquid Capacity-----------------------------gals. ._ Privy: Distance from nearest well------- -------------- .-__-__-..------------Distance from nearest b6ilding------------------------------------------ ❑ Distance to nearest lot line------------------~"------------------ ---------------------- x y----------------------------------------- Remodelin and/or repairing(g (describe):-------- '-- - ------ ------ I ----•----•-----------------------------•----------------------------------------------------------------------•-------- - ' ------------ ------------------------------------••- ----------------------•-•------------------------------------- 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. . w'' �' ,- - --- -----------( ' `Contractor) (Signed)-----,----------- E Bye ------_-- -•--------- ----- (Title) �� - t -F' -°---------------- (Plot plan, showing size of lot, loci on of Sys+em in relation to wells, buildings, etc., can be placed on reverse ide). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- - ------------------------------------------------- - DATE SFr` REVIEWEDBY----------------------------------------- ------- - - - -_ DATE---------- ^ -C-------------------------------•--- BUILDINGPERMIT ISSUED----------------------------------- -- ----_.--------------------- DATE-------------- . -- Alterationsand/or recommendations------ ------------ ----------------------- -------_-----=------------ -----------------------------------.----------- ------- -------•------------- ------------------------•-•------------------------------------------------------------------------------- ------------••------------------------------- ---•-------------------------------•-------••-----------------. - ----------------------------------------•------•--------------------------------------------------- ------------------------------------------------•------------------- ---........ --------- ----------------------•--- ' -----•--- •-------- -------------------------------------- ---------------- ----------------------------------- -- ------------- ---------------------------------------------------------------- _. a --- Date_... -----=--------------------- �� _3 FINAL INSPECTION 13Y:.-KL/ -- ------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street` .132 Sycamore Street t 814 North "C" Street Stockton, California Lodi, Cal"iforniaN. Manteca, California Tracy, California E5--9 145446 ATWOUD -