Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT Permit No. <br /> IC mplefe in Duplicate) <br /> Date issued <br /> Applica�ion is he-16-13Y Made to the San Joaquin Local Health District for a permit to construct and install the'wr2k*r :,-Q&4dV <br /> This application is made in compliance with County 0 di <br /> inance No, 549. P <br /> JOB ADDRESS AND LOCATION--- - ----- <br /> S - ---- - --- -- --------- ---------a-- --- ---- ------------------------------- <br /> Owner's Name .. .. 1117._1....... ---------- <br /> ------ --------_- ----------------------------------- -------------------------------------------- Phone <br /> Address ---------- -- --- ------ <br /> Contractor's Name---- 5---------- ----------- 04 <br /> Phonv V_J_ 1�`_f' <br /> f <br /> Installation will serve: Residence 9__11`cP­1r_f1nenf House E] Commercial E] Trailer Court E] Motel [j Other 1-1 <br /> Number of berooms _,T Number of baths .- <br /> Number of living units: __/---- d /--- Lot size ---- <br /> Water Supply: Public system E] Community system El Private Pf--tre—ptk to Water Table�a ff. 4 <br /> Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam E] Clay Loam E] Clay E] Adobe dl_-1� rpan E-] <br /> Previous Application Made- Yes El I No�_�Aew Construction: Yes4Pd3� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: 4 <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 4 <br /> Septic Tank- Distance from nearest wen'-45'0_-----Distance from foundation-_/_0....-.._M,teriak-A(L-11_L�_ 11 <br /> No. of compartments...... o�----------Size- ------Liquid <br /> d - ____Capacify_1Vj00L* <br /> Dispo I Field: Distance from nearest w6l_&_R-----Distance from foundation___'_ ____..Distance to nearest lot line----!� -/ Z_ <br /> XLT Number of lines------4-------------------------Length of each ------Width of french-_?--v------------- -- -- ----- <br /> Type of filter material.___...4! _�_ _ -v4-Depth of filter material.... -- -----Total lengfh---.Ie - - - - <br /> ----------------------- <br /> Seepa Pit: Distance to nearest well----------------------Distance from foundation--------------..._-.-Di5fance to nearest lot line. <br /> �EL Number of pits----------------------Lining material--•--------------------Size: Diameter-----------------------Depth--------------------------------- <br /> Cesspool: Distance from nearest well_________________Distance from founclaf on------------------- Lining material-------------------------------------- <br /> Ej Size: Diameter.-- ' --------------------------- ----Depth-------------- -------------------- ----------------Liquid_Capacity---------------------------.gals. <br /> Privy: Distance from nearest welL------------ ----------------------------------Distance from nearest building_____________.-_______------ <br /> ❑ Distance to nearest lot line--------- - ----------- ------------- <br /> I --------------- <br /> Remodeling and/of repairing (describe):_____.__.______.._.._ --- -------------------------------------------- <br /> I <br /> ---------------------------------------------- <br /> -----------------I---------------------------------------------------------------------------------------------- ----------------------------------:---------------------------%A <br /> -----------------------------I---------------------------------I-----------------------------I------------------------------------------------------------------- ------------- --------------------------------------------- <br /> -----------------------------•------------------------------------••-----• <br /> -----------------------------------­ <br /> -------------------------------------------------------------------------- ---------------------------------I--------------I------------------------------I------------------------------------------------------------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Courify <br /> ordinances, State laws, and rules and re6gulati ns of the San Joaquin Local Health District. <br /> (Signed)---- ------- ------ _ - --- ---- <br /> -- ---- ------------ ----------------------- ------------- <br /> . . ....... ............ <br /> --------------------------------------------------n__ _PW"LAM&_0r !;onfracfor) <br /> By44_3_1�p!- ------------- --------- -------------------------------------------(Title)-------------------------------------------------------------- <br /> (Plot p6, snowing 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-------- -- <br /> REVIEWEDBY -- --- --------------- --------------------------------------------------------------- DATE_ ­ ---------------- ---------- ----------- <br /> ­ I----------------------------------------­ DATE---- - <br /> BUILDING PERMIT ISSUED---------------- ------------ DATE. /� -------------------- <br /> --------------------------------------------------------------- ---------------- --------Q --------------------- <br /> Alterations and/or recommendations:--- --- ------------------------ <br /> -------------------------------------------------------------- <br /> :-------------------------------------------------------------------------------------------------------------------------*----------------------------------- <br /> ► <br /> ----------------------------------------------- ----------------I------- - ------------------------ ----- -------------------------------------------------------------:------------ -------------------------------- <br /> ----------------------------------------------------------- ------------------------------------------- -------- ----------•-----------•-------------------------•------------ ---_------------------------ <br /> -------------------------------------- -------- -------------------- ---- ------------------------------ <br /> ------------------------------------------------------------------------------------71------*---------------- <br /> -, ", -- <br /> FINAL INSPECTION -------_-------------------- Date-- ----------------- , <br /> SA <br /> SAN JO AQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street k 300 West Oak Sitect 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> Es--9-2m 145446 ATWOOD 12-54 <br />