6363 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. -----(1� -------------- (Complete in Duplicate) Date Issued _________ rg� 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 AWD LOCATION—fio-Z _43,16--yr-----145-6----- ......000 ......... --------- - -------- Owner.s Name---WAA� - -------- --------------------- ---------------- Phone------------------------------------ Address_.._4q_1_. 4W*1 ------------------------------------------- ---------------------------------------------------------------------------------------------- 'Ji I Contractor's Name____- ------------------------------------------------------ Ph n o a*%--4 Installation will serve: Residence Apartment House E] Commercial E] Trailer Court [-] Motel [] Other ❑ Number of living units: Number of bedrooms Z_ Number of bafhs/--4r—[Lot size ----X1_$_k---------------------- Water Supply: Public system 4.,Communify system E] Private E] Depth to Wafer Table _Wo7f. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam 0 Clay Loam El Clay El Adobe 4 WFirdpan ❑ Previous Application Made: Yes E] No it—New Construction: Yes �}.�la.[j TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi Tank: Distance from nearest wello-Olk". - --Distance from foundation_---/P- Material__4f0 -4 0 No. of compartments..—._.4__________ __-_____Liquid depth-_1#1.4-------------Capacity.-4%0F fr Disposal Field: Distance from nearest well-.._Distance from foundation--- ......Distance to nearest lot line--l-C.,.... Number of lines---------/-------41�------ --Length of each line....... ---_------_-Width of trench___A.V�--------------------- 0 Type of filter material---I.-L—Rk-Depth of filter material-----hr---------Total length ---------------------------- Seepage Pit: Distance to nearest weII#714%—_-.-f------Distance from fou dation__._jpd ------Distance to nearest lot line__ Number of pits------/--------------Lining material---p4ousz..Size: Diamefer-2j?--..---- ----Depth----ALO-.10---------------- Cesspool: Distance from nearest weEl-----------------Distance from foundation--------------------Lining material-------------------------------------- El Size: Diameter--------- ----------------------------Depth----------------------------- -------- -------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well------------------ -------------------------....Distance from nearest building------------------------------------------ ElDistance to nearest lot lire---------------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):----------------------------------------- ---------- ------------------------------------------------------------------------------------------------ -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------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 regulafions/of the San Joaquin Local Health District. (Signed),---- --- - - ------- ---- -------- -- -- ------- -------------------------------------------------------- Contractor) By:--- -- --- -- - ---- ------- -----------------------------------------------(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-------- ----------------------------------------------- Aih. -� 'k, ----------------------------- DATE----��7 REVIEWED BY---- ------ ------- ------------------------ ------------------------------------------------ BUILDING PERMIT ISSUED. DATE------------------ ------------------------------- Alterations and/or recommendations:------- --------- - ---- ....... . ---- ------------------------------------------------------------------------------- -------------------- ----------------------------------- ------------------------------------------------- ---------------------------------------------------------------------------------------------- ----- '• ----------------- ---------- ---- ------ -------- ---- ---------------------------------------------------------------------------------- ----- -------------------- ----------------------------------------------------------------------------------------- ------------------ ---------------------- ------- •------------- ------- --------------------------------------------------------- ----------------------------- -------------------- ------ -----------------------------------------------------------------------------------10--------- ----------------------------------- FINAL INSPECTION BY-.,---- -------- --------------------- Date------- ------------------------------------------------------------------------ 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 LS-3-2m 145446 ATWOOD 12_54