7173 - Laserfiche WebLink

Home Browse Search

APF ICA1l'ION FOR SANITATION PERMIT Permit No. . __ . �n'7 (Complete in Duplicate) Date Issued ..-.- n Applica�ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. Y This application is made in compliance with County Ordinance No. 549. ------------JOB ADDRESS AND LOCATION------ --- -- ---- -------------- e------------------------ Owner's ti Name-------------- � r ------------- Phon - e Address------------------------- ---------------------------------------------------------------------------•- -----------------------------------•----------------•--------_-- Contractor's Name. Cd�f�.4t.I --•-------------------------------------------- Phone. Installation will serve: Residence apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other. ❑ Number.of living units: -1----- Number of bedrooms ._`; (�funrber of baths J---- Lot size _--_-- ------------------------- Water Supply: Public system [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 E4—Hardpan ❑ -`-`''Previous Application Made: Yes ❑ No Dl�ew Construction: Yes [ o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if pu lic sewer is available within 200 feet.) 5 Septic Tank: Distance from nearest wellA_41_-P.,_Distance from foun tion._- rh Material. ------ Sept i�lo. of cam artments_-_---."'`/_�'.- ---.Sized T`4 I e --- -_ --- _ ' iCa aci 7f - --- -� . Disposal Field: Distance from neares well/f/",E._Distance from f //! -- ___..--..Distance to nearest lot kine.... __ ----- 1 -~ . Len th of each _.... _. idth of trend �� Number of lines_ ----- .. r, 9 _ - Fit ` Type of filter material ISl1 Depth of filter material.._..f' ----.....Total length. -+ Seepage Pit: Distance to nearest well--_�.r)'.(. .....Distance f m u dation,f,�r ....-_.Distance to nearest lot lin .__J0, Number of pits.... . .........Lining material. . ze: Diameter...._ __,----Depth___--;;u' ��.__- _ Cesspool: Distance from nearest well.-_-------------Distance from undation------------------- Lining material------------------------------Iq r -- -�._-.:._.:.-.—Liquid Capacityr.------ Privy: Distance from nearest well-_..------------------------- ---- from neares+ building-- ------------------------- ----- 1 -*.r ;: El Distance to nearest lot line------ --------------------• ----_--':__------------------. ---------••------------------------------------------- i _ Remodeling and/or repairing (describe):...... . A�� i k --------------••----------------•- --- *11-------- - - - -----------------------•-•------------- ------------- V __ -------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances to laws, and rule nd regulations of the San Joaquin Local Health District. J (Signed)------- --- -- - ---- --------------- --- --------------------- --------------------------------------- -----(Owner and/or Contractor) ---------------------------------------- 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----....... ................... F -� --------- ------ DATE----------- REVIEWEDBY--------------------------- ---------- ---- = = DATE----------------------------------------------------- ---- BUILDINGPERMIT ISSUED---------------------------------------------------------------------- ------------------------------- DATE-------------------------------------------------------------- i Alterafians nd/ar recomme dations:--_ .*t. c ---------------- - =' ° . -------------------- -------------------- --------------------------------------- -----------------I---------------- ---------------------------------4 FINAL INSPECTION BY: Date-------- .f3-... --- =4 pi SAN JOAQUIN LOCAL HEALTH DISTRICT t 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C Street Stockton, California Lodi, California Manteca, California Tracy, California F , E5-9-2M 145444-ATWOOD 12.54