8603 - Laserfiche WebLink

Home Browse Search

i APPLICATION FOR SANITATION PERMIT Permit No. ..... j (Complete in Duplicate) _ Date Issued ___-3/1 /1 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. 544. JOB ,ADDRESS AND LOCATION ------ ------ --_----.__ � �- f -�j T39 , ' '-•"^-- 1J ! ------ --------------- Owner's Name...... ,�--•--- ------------------- - Phone- Address--------- - -:. �� t - ---- ----------- --------•----------- --•-----------------------------------• ----------------------------------- Contractor's Name-------j C Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [] Other I ❑ Number of living units: __j----- Number of bedrooms -:Number of baths ._�_--- Lot size .�_�_-'�C--_I-- -o• ' - --------------------- Water Supply: Public system Community system ❑ Private.`❑ Depth to-Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Graved p Sandy Loam E] Clay Loam ❑ Clay [I Adobe Hardpan E]Previous Application Made: Yes ElNo� New Construction: YL- No ❑ ;� ; TYPE:OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) - Setic T- k. Distance from nearest well--,---.------_-_Distance from foundation--------------------Material--__---_----"_-.---------._.---.----.__ I h No. of compartments--------------------------Size--------=-----------------------Liquid depth------ Capacity ---- Disposal Field: Distance from nearest well-----------------Disfance from foundation--------------------Distance to nearest lot line----------------- P5 +�� _ _Number of lines-----------------------------------Length of each line--------------- ---------- Width of french---- --_-- -------------------- r Type of filter material------------------- --- ---Depth of filter material-.---------------------Total length--------.-------------------- Seepage Pit: Distance to nearest --------Distance rom foundation---1-0----------Distance-to nearest lot lire f Number of pits-- .----L.--.___-_--Lining material- C„-----Size: Diameter.-_.-&-_------------Dept h---a-- -------------------- Cesspool: Distance from nearest well---_.-..____-_ Distance from foundation___ ____________ Lining material__..- __________-_ - ❑ Size: Diameter_------------------------iDepth r` - Li uid'Ca acct „.� ----- gals: Privy: Distance from nearest veil--- -----•______-_--"------------ ---------------- Distance from nearest buildin ❑' Distance to nearest lot line - -- -- -------- 9------------------------------------•------------- ------------------------------------------------- --------------------- Remodeling and/or repairing (describe):----(.1`- ---------------------------------------------------•-...-------------- ---------------•-------------------------------------------------------- ----------•- .... t --------------------------•-------•------I-•---------•-------- -----•-----------------------------------------------------•-------•----------------------- -------------------------•----•---------------------------- ---- " -------------------------------------=----------:------------ -------------•------------------------------------------•------•---------•----------------•-----------------------•---•--•--=------------------- ---------- \ I hereby certify that 1 have repared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and a an r ulations of the San Joaquin Local Health District. (Signed)_-- ____ • . caner and/or - - ---- ----------------------- By: ---- --------------- (OContractor] BY: ---------- ----------'------ --------------------------------- _ - -- ------ - --------------- ----------------• (Title)-------------------------------- --•-------- ----------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). y � f . FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- -------------- ---- ----- - DATE----- REVIEWEDBY-------------------------- ------------`---------- - - � ---- ---" - ----------------------------------------------•- ------ DATE PERMIT ISSUED---•------------+----------- --- f -----------. DATE------- . •. •--•- -- --- --- ----- ---- Ite�atio�and/or recommends+ions:- ---- ------ --- "--------- ---------------•----------- ---------------------------- ----- - } - - ------ �' ------- ----- i "` `� L -------------------- - ---" --- --------- ---------------------- =--------•-------••-------------------------- bh f.-------- -------------------------------- ------------------- ----------------------------------------------------------------------- FINAL --=------------ -- F1NAL INSPECTION BY:.------ Date 4 �„ - - - --- --------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South.American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California -Lod;, California Manteca, California Tracy, California �ES-9 145446 ATWOOD