Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT Permit No. .. --.Z�-....... <br /> (Complete in Duplicate) f�� <br /> Date Issued --------- <br /> and <br /> .------ - �-- <br /> Il . <br /> Application 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 /> JOB ADDRESS AND LO ATI ------- - ----- <br /> -------- Phone------------------------------------ <br /> -------------- <br /> Owner's <br /> ----------------------------------- <br /> ---- <br /> Owner's Name------------- !----- <br /> —, ----------------------------------- <br /> . -Address ----- ---•-- ---- <br /> Contractor's Name.----_-------------•- g Poon <br /> ----- - - <br /> --------- <br /> Installation will serve: Residence Apartment House ElCommercial ❑ Trailer Court El Motel 11 Other.[] <br /> Number of living units: __i___ Nu ber of bedrooms -3. Number of baths .- _ Lot size ------ ---------- <br /> Water Supply: Public system mmunity system E3 Private epth to Water Tablet. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gavel M. Sandy Loam ❑ Clay Loam ❑ Clay E] Adobe ardpan ❑ <br /> Previous Application Made' Yes El No ew Construction: Yes [jNo ❑�a<� .�--- <br /> TYPE OF 1NSTALLATION''•AND SPECIFICATIONS: ., <br /> (No septic tank or cesspool permitted if pu : c sever is available within 200 feet) r� <br /> Septic Ta Distance from nearest well_ _ .. -____- Distance from foundation------- _-;'_..Material------ <br /> ________________-..____.____._ --.�... <br /> compartments Size-- ' ` -Li Liquid depth ._ �� Capacity q i? <br /> No. of. � � <br /> Disposal Feld: Distance from nearest well .--Distancefrom foundation___ r---.Distance to nearest lot line----142-_-_ <br /> ktd' - i, <br /> Number of lines------ _____ .--_ -- - Length of each line___ .-----_ _ Width of trench_______ ___----------------- <br /> T e of filter material ----Depth of filter material__-_._f ... -- �otal ler<gth-------. ---e----------- <br /> Yp <br /> .i <br /> Seepage Pit/ Distance to nearest welt- �_ ----_DistancAW' <br /> m foundation___"-Z_r _---. ist nce to nearest lot line- _____.___._ <br /> � Linin material. Sixe: Diameter-- /I------.Deptn______. - --------------•- <br /> r of pits--/ ----------- - 9 1------- - - - <br /> Cesspool: Distance from nearest weil--------_--------Distance from foundation---------.---------.Lining material-_.----___.._-__..___-_-_____.______ <br /> 171 Diameter <br /> Diameter <br /> -----Depth-------------------- - ------Liquid Capacity- ------------------••--•---gals. <br /> Privy: Distance from nearest well----------------------------------- ----------- -Distance from nearest building----------------------------------------•. <br /> Distance to nearest lot line_____.---.---------------------------------- •----•----------"---- - <br /> ---------------------------------------•------------------ <br /> Remodeling and/or repairing (describe)---------------------------------------- -------------------------------------- <br /> -•- •----------------------------------------------------- <br /> ____________ <br /> h ___________________________________________ <br /> -------_------------_------------------------r-----------------------..--------------------------_.-____-___.-____-.._____•-_____..___-_______._______-_______..___________.___________________--.-______-_____-_____._________ <br /> I hereby certify that.] have prepared this application and,thatythe work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and 161As ereda,�ions of the San Joaquin Local Health District. <br /> Septic Tank Service -- -�or Contractors <br /> (Sign --- T20a 16--£lduxadv---HO-2-20'�fi --------- ---- <br /> ed) �---s <br /> By:__.. <br /> 5totktianl Calif, / `r - ---- -----(Title) -- = <br /> (Plot plan, showing size of lot, location of system in relatio4 to ells, buildings, etc., can be placed on reverse side). <br /> FOR DEWRTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----------- ----- ------- - -- -- ----------------- •- ---------- DATE--------­7n----------------------------------------------- <br /> DATE----------- <br /> BUILQING PERMIT -1------ ---------- ----- ---- ---------- ------------------------------------------------------ ----- ------------------------------------------ <br /> BUILDING <br /> ----------•--- ------------------------------ <br /> REVIEWED BY <br /> DATE_------- �� <br /> ISSUED ------ - -- - <br /> Alterations and/or recommendations------------------------ '" <br /> --,--� --- ------- ---------- --•---- r T <br /> -- ---- - -----•-------•-V-�----­-------------------- <br /> ------------------------------ <br /> --- -------„ --------------- ` f �� -- -- rte-- -- -- ------------•-•------------------- <br /> ---------- •---------------------------•---- <br /> ------ ... -••-----•------- <br /> ------------ -------------------------------------- <br /> FINAL INSPECTION BY------------- --"-- --- -- ----- -----•---- <br /> Date:.._-�--� <br /> II SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> Sycamore Street $14 North "C" Street <br /> 130 South American Street 300 West Oak Street 132 5 Y <br /> Stockton, California <br /> Lodi, California Manteca, California Tracy, California <br /> ES-9 145446 ATWOOD <br />