Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
APPLICATION FOR SANITATION PERMIT Permit No. .. .... <br /> (Complete in Duplica+e) t° G <br /> bate Issued <br /> Applica{ion is hereby made to the'San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> v <br /> JOB ADDRESS AND LOCATION_ <br /> �... ---------��it'_%-.�-----01,,5- ------ <br /> Owner's Name = 46 _O C - ------------- Phone. ........ <br /> ,7.3�a 7 <br /> . y 8 `' '-----��------ ---------------------------------------------------- = <br /> Address_.___... __ <br /> Contractor's Name---- ' /5 Phone_ ifo _p�4.,7_.. R <br /> '•--- <br /> Installation will serve: Residence ,��A Apartment Douse ❑ . Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __�_--Number of bedrooms __ Number of baths ___/__ Lot size .__1. . --r--�..---- ---°.�----------------- <br /> Water Supply: Public system ❑ Community system ❑ Private Depth-to Water Table; p ft. <br /> e <br /> Character of soil to a depth of 3 feet: Sand El Gravel F1 Sandy Loam El Clay Loam ❑ Clay El Adobe[�}--Hardpan ❑ <br /> Previous Application Made: Yes ❑ No [k--New Construction: Yes [g--No ❑ /4-1/re,Q F e •\ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank- Distance from nearest well____------Distance from four dation_�'�Z___ .___.Material-____ _ _____--___.__________.________...-. <br /> No. of compartments_---- -- ------Size___ __ 6---- iquid depth-- ----------------Capacity--- d0 <br /> Disposal Field: Distance from nearest�well_._,rt.d_--____Distance from foundat•on.l+�Q_.-- --Distance to nearest <br /> Number of lines---------- 0-----------Length of each line__ -------- -------Width of trench----------- ------------------_-- <br /> Type of filter material__,!----S?q_-.Depth of filter material-_--/S..........Total length------,F------------------------- <br /> ___ <br /> Seepage Pit: Distance to nearest well.l4-a______:_-_Distance from founds+ion__.�6_-__ bista��e to nearest lot line, __.____ <br /> ®� Number of pits--------- ---------Lining material__sr/�.'L---Size: Diameter----- ---_-------Deptn___-- -3-_____------------- <br /> i <br /> Cesspool: Distance firor4neare5t well-----------------Distance from foundation._.__.-___-:-__._ __.Lining materia------------------------------------- <br /> 171 Size: Diameter------------------------- ----------Depth---------------------- - -------- Liquid Capacity gals. <br /> Privy: Distance from nearest well______________ ---------__------------------------Distance from nearest building-________-_____---___________----.------. <br /> ❑ Distance to nearest lot line--- ------------------- - ----------------------------•--------------------•----------•-------------------- <br /> 7 -T-- -R--__.. ff USS-------- <br /> Remodeling and/or repairing (describe):__----- --T m--_;_---_____-�dX--.--------•�----- <br /> •---------•------------•------••--••--•-I----------------------------------------------------------------------------------------------------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, S e laws, and rules and regulations of the San Joaquin Local Health District. <br /> /✓`/� � L-` ------------------------- ---------------------- (O or and/or Contractor) <br /> (Signed _ Nowing <br /> --- - <br /> -------------------- ------ <br /> By: ------(Title)---- -• -- -----`---------------------------------- <br /> - - -- - ------------------------------- <br /> (Plot plan, size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---------------- ------------------------------- DATE----�---------------- ------------------------- <br /> - - ------- ---------------------------- <br /> - DATE ---------------------------------- <br /> REVIEWEDBY------------------------------------------------- ------ ---- --------------------------------- <br /> BUILDING <br /> ------------------------------ <br /> BUILDING PERMIT ISSUED----------- ----------- •-------- -- ------------ ----------------•-•- <br /> DATE------- � . <br /> Altera+ions and/or recommendations: - ---•------------------------- ------- <br /> J <br /> ----- ---- ------------- - --------- <br /> --------------------------------------------------••-----..----------------------------- <br /> -------------------- <br /> Date_ <br /> ------------------------------------------------------------------------------ <br /> t ro — <br /> FINAL INSPECTION BY----------- ------------------- ------------ ---------------------------------------- <br /> .. .----...-- - - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South Amerk*n Streof 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy. California <br /> ES--9-2M 145446 ATWOOD i2-54 <br />