6012 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. __tr..JC1 " (Complete in Duplicate) I Date Issued c0�'S !eD -2$' Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. e 23 0 IV. 6�- O a k v C t Lo 'TP_rr,cf c.R_j JOB ADDRESS AND LOCATION...A/__C�--SS /Q�1.Q, b_rjA1Z-1 - -I------ -------------- ----------------------------------....------------------.---------••-- Owner's Name------ _0 f~ h- ----•---- G h- i --------------------------- Phone.----•----------------•------------ Address--- ` - Y� a � Y^ � �- ----------------- •------------------------ p l ' /� F x� /Phone--------------------------------- Contractor s Name..-- �--5�-------�----�._..-�__�_f.�._K��-L�`-$-�:r--------- .. --------------------�-------•--�- - Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ i Number of living units: --I----- Number of bedrooms .Z.- Number of baths -1.... Lot size _J-PS,-----%---r9b---- ________________ Water Supply: Public system ❑ Community system ❑ Private R1 Depth to Water TableliO___ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe, Hardpan ❑ Previous Application Made: Yes ❑ No's' New Construction: Yes114, No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-.r -6r..__Distance from foundation-�-�----_____..MatenaL_ Q. --�-�_S�--- ------------ No. of compartments---�----------_ ----Size- -- -_1_- _-- Liquid depth----4----------------Capacity__-©_b-----. Disposal Field: Distance from nearest well.A_d._0...Distance from foundation---/_.0....__....Distance to nearest lot Ii W Number of lines_.-.,.—.--- --------- _______Len th of each line__-_-f0_________________Width of trench_-�_�.----------..__-.-_-_ - Type of filter material ke_T6 f filter material_---�t�'-v.--.---Total length------J.A.Q-1____________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation_-__--..._.-____.-. Distance to nearest lot line__-.__________-_. ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth-----------------.--------------- Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material-_-.--....____-_____.______.__.______ El Size: Diameter------ -------------- ------Depth-------------- ---------------------------- ----._.-Liquid Capacity----------------------------gals. Privy: Distance from nearest well_-_---------------------- -----------------Distance from nearest building--------------.------------------------_. ❑ Distance to nearest lot line----------------------------- -----------------------------------------------------------------------•---------------------------------------- Remodeling and/or repairing (describe):---JV C--k„)_-__Cid_s--S. `_ _ _ _d_. --------------------------------------------------------- •-------------------------•------•-------------------------------------------------------------------------------------------------------------------------------------•-••--------------------------------------------- ------------------•-------------------------------------------------•--------...-------------------------------------...---------------------------------------------•-------------------------------------------------- -------------------------------- ---------------------•-------------------------------------- •---------------------------------------------•-------------------------------------------------- ----------------------------- 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 regulations of the San Joaquin Local Health District. (Signed)--- ----- -------••---------•------ -------------------- - ----------------- -------------------------------------------------------------- --------(Owner and/or Contractor] By:.---- - - ------ (Title] (Plot plan, owin ize of to+, location of syste in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- ---------- ----- ---------------------------------------------•----------- DATE------ ---------------------------------------- - REVIEWED BY----------------------------------------- - - - ------ ---------- ----------------------------------------------------- DATE--- ----- • - - ------�---• �- ----------------- BUILDINGPERMIT ISSUED------------------------ --- -------------- - ----------------------------------------- --------- DATE---------------------------------- - Alterations and/or recommendations:................ ... -------------- r ----------------------- FINAL INSPECTION BY:. .. Date ------------.=.j-- �`5 ----------------------------- 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 E51--9-2M 145446 ATWOOD 12-54