5172 - Laserfiche WebLink

Home Browse Search

/ / �W- Y APPLICATION FOR SANITATION PERMIT Permit No. ✓�' _ ' (Complete in Duplicate) S+ �p Date Issued Applica+ion is hereby made to the San"oaquin 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-------------I+4.t.__----_-__-_-.._____ Wilkerson.•Manor-------------------- ©h'Cp—030 �7 Owner's Name--------------F 9y:d_.&_.Wi1kerson Phone - -------------------- ----- ------- Address------------------------------------------------------------------------------------------------------------------------------------------------------..........-.-•- -.....--...-------------------------------- Contractor's Name-----------------abOVe---------------------------------------------------------------------------------------------------------------- Phone----•------•-------------------- Installation will serve: Residence [elA*'partment House.❑-•Commercial-❑Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ ____ Number of bedrooms _Number of baths ___ ___ Lot size _______ _.f- s __�f Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe'Pl-"'Hardpan ❑ I � ; Previous Application Made: Yes LTJ"'ivo- ❑ New Construction: Yes1PRO'*'�o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: p� f (No septic tank-or cesspool permitted if public sewer is available within 200 feet.) Septic Distance from nearest well--- ------Distance from foundatior}� _____________.Mate is._ •_____._ ._ .._ - � - ------------------------- - No, of compartments-_ - _____________Size,A_,__f'�__ ---.Li Capacityep--2' _ ) . Disposal eld: Distarice from nearest well tDistance from foundation__-r__ _.-4-.--Distance to nearest lot lin .�,.__-...` -__ Number of lines_--________03e-___ __________Length of each line _.."_ _._.Width of trench E Q •- Type of filter materia{ a[1�___Depth of filter material___._ Total length_____________/�_�, _________.. Seepage Pit: Distance fc nearest"welt _____--------------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__.---------------------------------- ❑ Size. Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity--------•--•---------------gals. a Privy: Distance from nearest well-------------------------- ______J-____-___--.._Distance from nearest building-----._.---__---_______-______ ❑ Distance to nearest lot line-- -------------- ------- ------- ------------------------------------ ------------------------------------- ----•------------ 2 Remodelingand/or repairing (describe):--------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------_-------------------------------•--------------•---------------------------------- ----------------------------------------------------- ----------------•------•---•----------------------...._.---------------------•-•------•-.----------__------:_:-------------•--.....--•---......-...--------------------•--•------•----------------------------------------- ------------------------------------------------------•--------------•---------------------.-..-------------- -------------------------------••---------------------------------------------------------------------------- I hereby certify that I have prepared this application and the�',the work will be done in accordance with San Joaquin County ordinances, Statetlsws, a rules a regu ions of a ,San Joaquin'-Local Health District. ________-_--_-'-`_. Owner and/or Contractor By: - . Y•----•-------------------------------------------------------•-•-=---------- ------------=-----••-•- ------•-----,----------------(Title)-- ---------------------------------------------:-------------- (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc:; can be placed on reverse side). u FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY------------ --------- ------- ---------------------------------------------------------------- DATE------ ---------------- -' .--------------------- REVIEWEDBY--------------------------------------------------- ---------------------------------•-------------------------------------:__ DATE BUILDING PERMIT ISSUED= _ } -------------------------------------------- DATE. ' / --------------------------------- Alterations and/or recommendations.------- - -- ---- - ----------------•--•--•-----------------------------•---------------•• --------- ------------------------ -----------• -------------------------- ' --------------------------------------------------------- ---------------------------------------- ..... ---------•I----------------- ------------------------------------- ------------------------------------ ----------•------------------------•--•------------------------------------------------------------------------------- •--•-•--•-•-----------•----•--.-.--•----------------------- ---------------------------------------------------------------- - FINAL INSPECTION BY::----- - ---------------------------- Date---------------` ------.2----------------------------------------------------- -_------------------1/s� 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 c ES-9-2M Revised W-2100