8428 - Laserfiche WebLink

Home Browse Search

r `;1 11�k IO APPLICATN FOR SANITATION PERMIT Permit No. ...g--`f-•1 -- *, 1 r (Complete in Duplicate) � LDate.lssued 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. -- -" JOB ADDRESS AND LOCATION__ __ Phone Owner's Name.:__:-"-- - s " - ----------------------•------ -- - - Address...--- ------ on :7 " ---� -' Contractor's Name------ ____fie ---. ____ -- Trailer Court ❑ Motel ❑ Other ❑ Installation will serve: Residence Apartment House ❑ Commercial ❑ Number of living units: _/---- Number of bedrooms ?Number of baths ___ _ Lot size __.__. -p---X-- th to Water Table Water Supply: Public system Community system ❑ 'Private ❑ Dep. E] Gravel E] Yes Loam El Clay Loam [I Clay E] Adobe Ea_ Hardpan Character of soil to a depth of 3 feet: Sand ❑ Previous Application Made: Yes F1 No V_.New Construction: Yes �No El TYPE'OF INSTALLATION AND SPECIFICATIONS: (No septic tank or jcesspool permitted if public sewer is available within 200 feet.) . twel -----------------Distance from foundation.--- ----.Material------------------------------------------------- Septic Ta k: Liquid dap h________________ Capacity.-________.___--------- ❑ Nocom artments_ Size ------------------------Disposal Field: ' istance from nearest well-----------------Distance from foundation.-------------------Distance to nearest lot line----------------- ber of lines------------------ --------------Length of each line-:--------- ---------;-'-----.Width of french------------------ ype ---------------- ❑ of filter material-------------------:-----Depth" of filter material----------v.-----,C1Total length----------------------------•----------t /�7 —t�istance from foun anon__ v------Distance to nearest lot line__ ------ Seepage Pit: Distance to nearest well_.__111-__"""------- jJ j ze: Diameter---._�.3.- ---Depth_----�-,-mol-------------- B- Number of pits---/-_______________Lin ing materi -_ _ ._- Cesspool: Distance from nearest well-----------------Distance from foundation________________..lining material------------ C Li uid Ca acit gals. 0 Size:'Diameter_ --- -'--- ------- ------- '------Depth-----------------=------------ -----'-----'"- q p Y--'----------------------- --=---Distance-from nearest building Privy: Distance from nearest well- ----------- -- 6 Distance to nearest lot line' --------------------- ❑ •- :___.-__.____________ - ------ ------------ - --- • ' fi s.. Remodeling and/or 'repairing (describey:_---------------------------------- ------------------------------------------------------------.-.___________..____ ._________..____--.__________.. -___.. ---------------------------------------------------•----- ----------------------•-------------------------- --------•------- -- _..__ --------------------------- --------------------- ----------------------- -------- --------- 1 ---- -- ! hereby certify that I have prepared this application and that the work will be done in accordance_ with San Joaquin County ordinances. State and rules and regulations of the San Joaquin Local Health District. . ------ (Signed) ----------------------------------------------------- -----(Ow(Owner and/or Contract n d/o or) ------ --- --- -- .(Titl --- ----------- -------------- - By._._ ----- -------- --------------------- e -(Plo+ plan, showing size of lot, location of system in relation to-wells, buildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY ------------ = _ DATE_ ---------------------------------------------- APPLICATION ------'----------------------------- ---- ' APPLICATION ACCEPTED BY --------------------' DATE- - f= ---------------------•--=-------- REVIEWED BY------------------------------------ DATE-------------._. _ ------------- -----_ BUILDING PERMIT ISSUED------------------------------ ----"" --------------- -------------- '----------------- � -- '-- ---'----------- -------- ----------------------- Alterations and/or recommendations:___.__.:._.--- -----" ------------------ `�' = ' " n---: --------- ---------' ------------------------ -- Y ----...-----------------------------------.-------- ' ' ----------- --- r Date- .--- --�--f-----'.- ' ' ------------ FI AL -INSPECTION SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 13Q South American $treat Frac California Stockton, California Lodi, California Manteca, California y. ES-9 145446 ATWOOD r - -