8185 - Laserfiche WebLink

Home Browse Search

07s;V APPLICATION FOR SANITATION PERMIT Permit No. --. s " (Complete in Duplicate) _ wDate Issued Applica-lion 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 JOB ADDRESS AND LOCATION__----RIJ--------/6, Owner's Name--------- : �-- •---------- --------�.C.�9 "-- •-�:--('•- �:•5--- ----••-- - --- -------------- Ph Address �� .'"' .......Zvb ------ Contractor's --- one Contractor's Name------_ -- -.i- __ i '- - �' --------------•..-•--• --- w ' ------ ------- Phone Installation will serve: Residence Trailer Court Motel Other Number of living [��partmenf House ❑ Commercial El Trailer g units: ---/_IN mber of bedrooms / !z- "- Number of baths -- -_-.- Lot size _--_"-..--_---_- _ C,_ - t-' -j : - Water Supply: Public system Community system ❑ Private El Depth to Water Table ___.---- ft. Character of soil to a depth of I feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Previous Adobe ardpan ❑ Previous Application Made: Yes ❑ No Ne . w Construction: Yes �K1o'"❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ` Septic Talk: Distance from nearest wel1,,5_0--- ---Distance from ndation- .--- r �.,✓" - ��--.-----Material--..�✓e�� No. of compartments-rte_- f �/ r -------Sue-. - , .Liquid dept-"�_ �� Capacity-- -- • ---�= - Disposal Field: Distance from nearest well_ --____Distance from foundation---� - ""-.-Distance to nearest lot line -- --------_ ❑�� Number of ----Lengthlines.-_�---------------------# of each line--f 7. --------- � �f + -� ee Width of #ranch - ------------- Type of filter material. .--_Depth of filter material------ ____--Total length___.---. --_ - _. ------ IN I Seepage Pit: Distance to nearest well..._-"---_-----_�---Dis#ance from foundation-----__---...-----.Distance to nearest loft line-----------------❑ Number of pits----------------------Lining material----_----- - --.---._-. Size: Diameter------------------ Depth--------------------------- Distance Cesspool: from nearest well---------------- Distance from foundation--------------------Lining material___--------__-------_-- ❑ Size: Diameter-------------------------- --------Depth---------------.............. ........... ------Liquid Capacity---------- -----------------gals. Privy: Distance from nearest well--------------------------------------------------------------------------Distance from nearest building -------•-------------------- + ❑ Distance to nearest lot line_____________________. -- I --------------------- Remodeling and/dr repairing (describe):---_--------------------------------------------------- ------------------------------------- ------------------------ --------------------------------•----------.--------------------------------•----------•-------------------------------•----•----------•------•---••------------------------------•- ------------------- = '---------------'---tify-------•--'•----•-------••------•---•----•--------------•-•--------------•-•-----•----•-------•----------------"•--------------•--------------•---•--- -. r—'-'- hereby certify that! have prepared jt��hiis application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules &Efi1G� of the San Joaquin Local Health District. (Signed)--------- _ �� Se -tic Tank Service ----- -- --- n..- _ . 12QG So. EldoracTo I'1C7�=7Q��-------�-� --- - --------------- +�---_{Owner and/or Contractor) --------------------Stacktoj3,-C*IifA n.'6J1 Title) ' ' (Plot plan, showing size of lot, location of system in relation to wells,6suildings, etc., can be placed on reverse side). ( FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-__-------`.------ 5:l' fr_.P.-------------------- ---------------------------------------- DATE- REVIEWED BY- --------------- ------------------------ -. {��---`;-or -- . V------- ------------------------ -----. DATE-.--------- •------ - BUILDING PERMIT ISSUED--------------•--•---------___-- • -------------------------- --------- ----- --------•----- DATE-------- -----------•------------ -- A terations and/or recommendations:-:----_--...--_"-"..-______"__-.__ --- ----------------••-------•---------------------------------••-----------•----•-------•--•--...---••--••----••-----•---------- --------------------------- --------------- -- ------------------------- FINAL INSPECTION BY:------ J ---------------------- Date-..-1�-------J-- -------y a 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-9 - 34544E ATWOOD