7611 - Laserfiche WebLink

Home Browse Search

F APPLICATION FOR SANITATION PERMIT Permit No. t` (Complete in Duplicafe) J� Da�t[e Issued __S7�_ O 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 compl'arice with County Ordin nca No. 544. , ._. ..ww JOB ADDRESS A LOCATdON � - ---------- Owner's -Name----------- i_ •-- ----r ----- -T ---------------------- --- Phone---------------- ,. _ _ _ Address......�t. ? r --------------------------------------------------------------------------------••----------------.-------------- .. Contractor's Name..... •-------• -11--------- _ Phone ------------------ Installation . will serve: Residence r Apartment-House ❑ Commercial ❑ TT�? i, Court ❑ Moter ❑ Other ❑ Number of living units: __i�____ Number of bedrooms _. Number o aths. ot size - -- - -- - -------- ___ Water Supply: ' Public system T"" •-- - pp y� y ❑- Communifiy system ❑ Private Depth Water`Teble _._.____ ft., � Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ . Sandy Loam &I Clay Loam ❑ Clay❑ Adobe ❑ Hardpan ❑ C Previous Application Made: Yes E] No V New Construction: Yes [�No El TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tank or cesspool permitted if ubll'c si?we is available within 200 #ee I ' Septic nk: Distance from nearest well__ _-�!___.___Dist c rfrom {ountion_l-� ate i�l__ --------------- --•_- ,S --- No. of com artments-- ---------- - � QS--,..Liquid e tkr- -1-- ' p - Size -------- q 1� p Capac�tY -�------f ' Dis os l'' Field: Distance from nearest wel P�� i` f P - -.-..._D stance from found tion-thtance to nearest lot line__ Number of lines--------- ----- l- ---_--- �---Length of each line__ 0-- dth of trench.--------9Z/ ------- Type of filter meter --------.Depth of filter material____..- al.:length__-____-. SeepagaPit: Distance to nearest well ................._Distance from foundation-------------------:Distance to nearest' lot line.....-______.___- ❑' Number of'pits..`___________________Lining material ----Size: Diameter-- ---=-- --=-=----Depth----------- - -------------- Cesspool: Distance from nearesf-well__,__'-_.______Distance from,foundation..::_T______________Lining material .____.___-_-__.___._ ----- ❑ Size: Diameter Depth - - -----------------Liqui.d Capacity----------------------------gals. Privy: Distance from nearest well.------_-------_--------------------------------Distance from nearest building .. ❑ Distance to nearest lot line-------------------- -----` - ----------•--•----------------------------------- Remodeling and/or repairing [describe]_-------------------- -------_------- --------------------------_-- - --------------•----------------------•-------- F 1 - ____-__ ---------------------------- _•_...-------------------- --------- ____ ___ __________ _________------------------------------------------------__________________________ _ _ _______.___.________- ____________-.._._ .__ 10 ____ ______ -------- ________.______-.___..__..__-____-----___________--_-_.__.____-- hereby certify that I have prepared this application a� that thew will be d n in accordance with San Joaquin County ordinances, State laws, and rules and regula ions of the Sa oagh.�neLa al Health District. (Signed)---- tr!_� _.-- - --------------(Owner and/or Contractor) By:-------•--------------------- ------------'---------•------------------------=---- ----- ------------------------------------Tifle { ' 1 ---------------- (Plot plan, showing size of iot, location of system in relation o wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYb---------------------- --------------------- - --------- DATF��r.,... - --- -- -------------------- --- REVIEWED BY ---•---------- -. - ---._ DATE-- BUILDING PERMIT ISSUED_______ DATE - r ------------- ----------------------------------- Al+erations and/or recommen a ns--------------------- - -----------------------••---- --------------- - 4 -...--- ------------------------ �---- -- — -f - L� ----------��1�____.--'-rte ------------------------- ------- c Lr FINAL INSPECTION BY: Date.- -- ------f .-- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" S+reef Stockton, California Lodi, California Manteca, California Tracy, California ES-9 145446 ATWOOD