7723 - Laserfiche WebLink

Home Browse Search

07/7 -in -ar I APPLICATION FOR SANITATION PERMIT Permit No. :7/7...jF... .. (Complete in Duplicate) Date Issued ------------------ Applica-lion 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 Ord' once No. 549. Zoe JOB ADDRESS AN OCATION- ---- -----Anxz ------a-------------------------- ------------- ---------------I Owner's Name------ - -- -------- --- -�-- -- ----- -- Phone------------------------------------ Address.-......•... .. --;L------ - -- ----- .......... ---- - ----- -- ...........:--------•-•------- ----------------------- Contractor's Name................ ----------- --------------------------------------- -- ------------------------------ ----------- ----------------- Phone----------------------------------- Installation will serve: Residence X partment House F] Commercial E] Trailer Court 0 Motel E3 Other E] Number of living units: _.--I__ Number of bedrooms ---k�umber of baths ----I_- Lot size ------- -- ---- - —----------------- Water Supply: Public system El Community system F1 Private>� Depth to Water Table - t./f Character of soil to a depth of 3 feet: Sand E] Gravel [] Sandy Loam D Clay Loam El Clay 0 Adobe El Hardpan 0 Previous Application Made: Yes E] NOX New Construction: Yes K No D_ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se f' Tank: Distance from nearest well 5-1�0---Disfance from undo --- ----- --- ------- No. of compartments.... ----------SizeA -�apac-ty--- -- IK ftiquij �ep.th----------47�—. apacity--- -- Disposal Field: Distance from nearest 11 %-,7—DDisfan`ce from foundation------ -D.sfance to nearest lot line ----N474. I ine------ Number lines.-----------T:----------- ---/Length of each I idfh of trench------- --------------N 1K Type of filter material--- E-Depth of f4er material..... ___..Total length.__-____/..;Liz--------------------- Seepage Pit: Distance to nearest well----- ----------------Distance from foundation-------------_-----.Distance to nearest lot line----------------- D Number of pits----------------------Lining material-----------------------Size: Diameter---------------------._Depth------- -- ---------- - Cesspool: Distance from nearest well-----------------Distance from foundation-----------------Lining material_____-_-.___.________.__-____-____ D Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capaci --------------------------_g a ls Privy-. Distance from nearest well.................................................Distance from nearest building_________.-_.-.-.---._--._-.___.__._.___ - El Distance to nearest lot lin -----------------------------------------------------------------------I-------------------------------------------------------------- r Remodeling and/or repairing 2- --------------- --------------------------------- ------ ----------------------------------------- ---------------------I--------------------------------------------------------------------------------- 7 ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --- ---- -------------------------------------------------------------------I--------------------------------------------------------------------------------------------------------------------------- ---------- --------- ---- 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 -- - -- ----- -- ---- ------------------------------------------------------ ...........(Owner and/or Contractor) vyv: -------------------------------------------------------------- ------------- ----------------------------------------------(Title)------------------------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------- ---- - --- ----- - - ------------------------------------ DATE----------------- - ----- ----------- ------------- ------------- - -------- -- DATE------------ BUILDING PERMIT ISSUED------------- - - - DATE-------------------------------------------------- REVIEWED BY--------------------------------------------------------- - -------- -- --------------------------------------- --- --- ------------------------------------- it r f'ons and/or recommendations---------------.---------------------•--.------.-------------------.___---- ;t------ --------------- ------ -------------------- ----- -------- a ---?41--kw--- - ------- --- --- ------------------------------------------------------------ --------- ----------------------------------- ------------------------------------------------------------------------------0------V-190-L ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - ------------------------------- -------------------------------- ------ - ------------- -- - -- - ---------------- ----------- -- -------------------- --------------------------------------------------------- FINAL INSPECTION BY--------- --------- -----------1�-------- Date---- ------- ........... -- ----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 00 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Mreef Stockton, California Lodi, California Manteca, California Tracy, California EU9-2M 145446 ATWOOD 12.54