8667 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. -------- G- -7- (Complete in'Duplicate) Date Issued / J _-�_-- - ------ -Joaquin is hereby made to the ari 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. 1 JOB ADDRESS AND LO ATION �.1�•fllL ZNe� 1N_4J7?-eA__.lwe �-AEf l Owner's Name---- C.0_4_44---------- -------------------=--------------------- ---------- - -------- Phone-----------•.------------------------ 1 Address Q --.-�L�r.. _.e.. _,K7_!� ---------------------------- ------------------------------------------------------------ Contractor's Name ---- --=-- �-------------------------- ------------------------------- Phone--------------- Installation will serve: Residence 5j�_blparfinent House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/----- Number of bedrooms _Number of baths ./-- Lot size ._- -._ 2 ,.------------------------ Water Supply: Public system ❑ Community system ❑ Private4DDepth to Water Table dit. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe'Z Hardpan ❑ -.Y: Previous Application Made: Yes ❑ No,:E� New Construction: Yes' [] No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: " \ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: ' i nce from nearest well-----------------Distance from foundation--------------_-----Material _---.______-.--_---._-_..---_..------._-_----- Elf compartments------------- -----------Size--------------------------------Liquid depth--------------------------Capacity----------------------- Disposal Field: istance from nearest well-. ��---_.Distance to nearest lot line--_ y p ,��_____Distance from foundation_--_- Number of lines--- - --_- ------ - -------Length of each line----- Width of trench.__�-- -------------------- Type or filter material--- ..-_- Depth of filter material-----Y-.........Total length------ ----------------- Seepage Pit: Distance to nearest well,,/-.-.__ .----Distance fr m found0i ,f�---- Distance to nearest lot line--.210--or- Number of its.---./--------. Linin material-_ iameter__.. p g -----Depth----- r 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,----------------------------------------- El Distance to nearest lot line------------------ --- ------•--------------------------------------------•--------•--------------••-------- Remodelingand/or repairing (describe)-------- -- ------ -------------------------•---------------•----.------••-•-•-----•------------ ----------------------------------- ------------------------ -- -------------------------------------------------------•-----------------------------------------------•--------------•------------•-----------------------------------•--------------- --- --- I hereby certify that l have prepared this application and that the work will be done in accordance with San Joaquin County w ordinances, S aws, and rules and regulations of the San Joaquin Local Health District. (Signed)-- - ------------- ------- -- ------ ------------------------ - -- •------------------------------------------------{Owner and/or Contractor) J By:------------------- ---- ---- -=----"(1---- --- - Tale - ( � ) J- ----------------------- ---------------- (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-------- ----- ---------------------------------- REVIEWEDBY----- -------------------------------------- ----I---- ---- -------------------------------------------------------------- DATE - 1, BUILDING PERMIT ISSUED----------------------------------- --------------------------------------------------------------- DATE------------ - Alterafions d/p recommendations V ..=-- ---V_7_4 --- -------- •---------- ---------------- ---•---------------- ------ •-------- ------ FINAL INSPECTION BY-------------- ------ Date---------------------------- SAN -----------.------_ --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 ES--4 ;45446 ATWOOD