7431 - Laserfiche WebLink

Home Browse Search

� r Aiy 4 ��e t No. � 4�--1----- a�l APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date issued -_" _t-""- -••� Applica{ion is hereby made to the.San Joaquinou�}cal0 Health DlNoC 5for 44-a permit to construct and install the work herein described. This application is made in compliance County Tl --------•-------- ---- -------------------- - ------------------------- JOB ADDRESS AND LOCATION____`_ ___ __ __ _ "" 5��_, .. - ------ -... Phone- ------------------- Owner's Name.---------- -'-•--�-T----�--••--•--�-��--=-�---•�------••---•-------------- - - - - -------------------------- .`�� G�J'!`7 •- ------------------------------------------------------------ .Address---------•-------•------•- Contractor's Name_.-_� _711 Other E]Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ ize �YNumber of baths __.ir___ Lot s __�`�-.-��--- - Number of living units: ---L Number of bedrooms ___.___. ------- Community system ❑ Private Depth to Water Table��ft- A Water Supply: Public system ❑ y y Cla Loam ❑ Clay El Adobe E3*"'Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel El Sandy Loam ElY. Previous Application Made: Yes ❑ No U?--�New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: [No septic tank or cesspool permitted if public sewer is available within 260 feet.) C'� -Material ---------------- - Septic Ta k: Distance from nearest welLL�.:___.Distance from foundation__.______ - e4-t� , oma ---------- Size `�C�' "A 3`f Li uid depth_-"._� - ------- Capac�tY No. of compartments.._ -- ---- -�-- "---""-"'--- G '---Distan st well-04' ce from foundation_____-"_.__..__.....Distance to nearest lot line----------------- Disposal Field: Distance from neare � Number of lines" --------------------------------Length of each line Width of trench. ---- � Type of filter material-------------------------Depth of filter materiaL__._-_-_.____--.---Total length___"__________".___.___-"___._"___"".___._ F Distance to nearest lot line----------------- C Seepage Pit: Distance to nearest well_ -"_-"Distance rom foundation____------• • �j..`_'_ Dept'n_._ -Q..`------=------ - � i --"----- -----Linin materia4--- - --- -- - ------size: Diameter----- -- �� Number of pits.._ g Cesspool: Distance from nearest well-----------------Distance,from foundation__..---_.---------- ningmaterial --- LqCapacity_------•--------- •------ gals• Size: Diameter------------------------------- De t^❑ Privy: Distance from nearest well------------------------- Distance from nearest building---------------------------- ------ ------------------------ ----------------------------------"-------- ❑ Distance to nearest to line-------- ------------t------- -------------- -------------------- ---- --- -- Remodelin or re fir"n (describe): �- '•��`" ----------- -- --------------- ----------- ----------- / g � -------------------- z�- ------------------------------- ----------••-- --- -- •----- ---- - - u 'it—= = I hereby certify that l ave prepared this ap;p-l-i�efa�tion and tha the work will be done in accordance with rn oaquin County ordinances, State laws, and rules and regula+ions of the San Joaquin Local Health District. DAY &NIGHT I...."Z�� Contractor)Si ned[ 9 )-------- Sep1Tc Tank Serv1c� Ilk .Title _ L2A.--------•- BY: l2QG_So..lEhAorl�dQ__HO 2-7af{6 , [Plot plan, sho ize of lot, locR6�4+8Rrsr+ in relation + ells, buildings, etc can be placed on reverse side). FOR DEPARTMENT USE ONLY - ------------------------------------------------------ DATE---------"-----------f--------------------------------- APPLICATION ACCEPTED BY DATE-------------- - -t------------------------•---------- -------------- --------- ------------------------ REVIEWEDBY-------------------------------- -- --------- ------------ BUILDING PERMIT ISSUED------------------------------- - DA --------------------------- 51 i Alterations and/or,recommendations:----------------- -----------•---------------- ----------------------------------------------- --------------------•--- ----------------------------4---------_-_-_-----------.----- ------------- ------ ----- ---- -----•--------------------•- 1. ( :7------------------------------ -------- --- ------- ? FINAL INSPECTION BY-------- ------ ---- - Date...........�--.-----�-�---�S--- ---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Tracy, California Stockton, California Lodi, California Manteca, California y' '` �� ES-9-2M 145446 ATWOOD.�12-54 -'