7830 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. ..... ._ 3-d 1 (Complete in Duplicate) Date Issued --__7�3� -� 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, n •.. V 3 7..3'�v 77,-4r'67jw4 JOB ADDRESS AND COC TION- O_- f' ----ow-'s- m----xt1�_ ✓ 1 ._. --off' l e -------------- Owner's `r r 1 Owner's Name----MCSS'_.__._-. �± - - - - - Phone--- -------------------------------- _ Addres _ _ _ . _ - ----------------------------- --------- ri71.� � - o a�'�' ancf►- ©�' Contractor's Name-_:06-0 /�__!I[t�.�zl---•---- �_ �.a(CC I -- ------------- Phonehe__AA91q--- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court Motel (" � ❑ [-Other ❑ ,r r ' Number of living units: _6__ Number of bedrooms _ 6. , Number of baths . Lot size Q------------- Water Supply: Public system ❑ Communitys { LN stem y ❑ Private �lsepth to Water Table____":�:{t. Character of soil to a depth of 3 feet: Sand ravel ❑ Sandy Loam❑ Cl Loam Clay I ❑ y ❑. Adobe �ardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: a septic tank or cesspool p rmitted-if publicewer is available within 200 feet.) e Tan Distance from nearest well Q____--_DistancVrprn fou dation___ _ -------Materi`(No. of com artments_ -p _ ----- --------- depth_- --------Capacity_elp . ------- X 4o 4Rt-r Distance from nearest well......... Distance from foundation--------------------Distance-to nearest lot line__--___-____..___ Number o{ lines 4 Length of each line ------------------- Width of.trench- .1 15N - Type of filter material_______________ _ Depth of filter material_-__.__ i - Total"length-_ ---- -------------- Seepage Pit: . Distance to nearest welf----------------------Distance from foundation___..-___._'._____.Distance to nearest lot line---------------- CI Number of pits Lining material ---.Size: D • --- - [Diameter -.Depth----------- F Cesspool:, Distance from nearest well_________________Distance from foundation--------------------- -----Liquid Capacity----------------------------------------sal iriin material__,_____-...__ ❑ Size: Diameter---{ ----- =---- ------- --------Depth----------------------------------:-- -------- als. Privy: Distance from nearest well---------------------- - ---------------------Distance from nearest building'-, ❑ Disfiance to nearest lot line ------------------------------------- ------------------------------------ Remodeling and/or-repairing (describe)_------ -------------- ------------------------------ -------------------------------------------------- ----•---•-••---- -----------------••------------ ------------------•------------------- -•----•------•--------------------------•-------------- -i`, . - I hereby certify that-1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and recautaiians of the San Joaquin Local Health-District. DAY I h11HT (Signed)___- Se tic Tank Service 1206 So. Eldorado K0_2� CI46------------ -----{O""'ei` r Contractor) By:---' CaliF ---------- ----- ------- ---------- Stockt __ (Plot plan, showing size of lot, location of system in relation t ells, buildings etc., can be placed on reverse side). FOR DEPARTMENT USE'ONLY ' APPLICATION ACCEPTED BY__________________________ ______ ___ - '= DATE --------°' - �"�` REVIEWED BY ------------- ---------------------------------------------------- `-- ------------------------------------------------- DATE--- V BUILDING PERMIT lSSl1ED--------------------------- V' _ - .- ------ ---- -------- --------------- -------------�-------------•- -------- DATE.--- �--------=------- Alterations and/or recommendations:-_--------------_----- - FINAL INSPECTION BY:.. -------------------------- SAN ---SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street f 300 West Oak Street 132 Sycamore Street 014 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 185446 ATWCD0 12-54