8262 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No- ---1?._.'---_`•.Z- (Complete in Duplicate) Date Issued .--- --`.-'--`-____-- 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-- ---------------- �1 -" Owner's Name--- ---1?;�-t�------- ' - f ------ --------------- --------------------------------------- Phone.----------------- •--------- ------------------------- ------ Address........... ----:refLx� � Contractor's Name... "6 Phone--------------------------•------ 3 Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [❑ Other ❑ Number of livingunits: __Number of bedrooms __ Number of baths ---If- Lot size .1012 If -------------- Water Supply: Public system g"—Community system ❑ Private ❑ Depth to Water Table ��_ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe n—aardpan ❑ Previous Application Made: Yes ❑ No RJ"New Construction: Yes ❑ No E5]— • TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic;ink: Distance from nearest well_--------------Distance from foundation____.___..________..Material_______.._.-___________.__._____..-.._-_______.. 4 1. i No. of compartments--------------------------size_______________•---=--------__--Liquid de th_____.__----- --------_Capacity P. -- ----------------------- Dispos;al Field: Distance from nearest well .........Distance from foundation-------------------- Distance to nearest lot line--------.--------- Number of lines----------------------------..-----Length of each line------------.--------------Width of trench-------------------------------.--- 41Q4 1 Type of filter material-------------------------Depth of filfer material-------'-------------.-Total length------------------------------------------ r ` I i f le Seepage Pit: Distance to nearest well___ Distance from fou f ation____IR-__-___Distance to nearest lot lin�_�6�-____-__- 'V ' Number of pits-----.f_-__......__Lining materia��_ ��Size: Diameter__.._��t� .---.Depth------ Cesspool: Distance from nearest well________________Distance from foundation--------------------Lining material-------___.._____-_.___.__---_______ ❑ Size: Diameter------ -------------------------- ----Depth------ ----==--------- ----------------------Liquid Capacity----- --------------- -----gals. Privy: Distance from nearest well____________________________________________ ___Distance from nearest building-------.--___._____--_________----__-__._. ❑ Distance to nearest lot line----------------------- ---------------------••------------------- ----------- ------------- Remodeling and/or repairing (des cribe)_----------------_______.__ / __------_-- ...._.._._-•---'-----------------------'---------••-----------••---------....----•(M'gs="4z•=L-' -f: _ LtfY-^ C/L' '' C ,,,±±±= =-- ----------.------------------------ ----------------------------- __------ - ----------------•--- 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 re uI tions of the San Joaquin Local Health District. Si ned -tJr�` � 1-E "'r = !1- i.1`�"�--�— ------------------------(Qmer /,or-Contraetor) 9 ( } = By:-------------------............ = f r ! - --- --------------------------------------•- •---- ------(Title------'-�,�--- �'-- -- _ .��.�-----• ------ (Plot plan, showing size of lot, I dation of system in relation to wells, buildings, etc., can be placed onreverse se Ue). FOUR DEPARTMENT USE ONLY APPLICATREVIEWEDION ACCEPTED 13Y ----- -----------------• - - - ----------------- REVIEWED BY ------- ------ ---- --------------------------------------------- DATE PERMIT ISSUED---------------------------------- . ------ DATE.---- - .... _-..------------------- BUILDING - - - Alterations and/or recommendations:__.-------------------- -- --..----•--------------- ---------- ----- - - �-5.- _o--- -.----......-------------------- ••-_-- --- ----- ----------------- FINAL INSPECTION BY:.--- - - ----------------------- --------------- Date.- �-----� . ._ ------ SAN JOAQUIN LOCAL HEALTH DISTRICT t 130 South American Street 300 Wast Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9 145446 ATWOOD