1086 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. -----................ (Complete in Duplicate) + :..� "�� Date Issued __________________ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described, C This application is made in compliance with County Ordinance No. 549, JOB ADDRESS AND LOCATION---------------------------------52 -5 E. Weber Av. , -------------------------------------------------------------------- Owner's Name-------------Fred- Wilkinso 1----- -- -------------------------------------------------------------------------------------- Phone -513 9----------------- Address - �' Weber �. Contractor's Name DE1.t& -- -------- - --------------- Phone-------3- 255 Installation will serve: Residence [2* Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ '., Number. of living units: __Z___ Number of bedrooms __3--- Number of baths ___!__ Lot size --- 9X-Q5--------------------- ------------------- Wafer ____ -------------------Water Supply: Public system ❑ Community system '❑ Private [3: Depth to Water Table43____ ft. I Character of soil to a depth of 3,feet: Sand ❑ Gravel ❑ Sandy Loam ❑� Clay Loam ❑ Clay El Adobe E] Hardpan ❑ ' Previous Application Made: Yes ® No ❑ New Construction: Yes�> ] No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or cesspool permittedif public sewer is available within 200 feet.) A ' } �� I Septic Tank: Distance from nearest well _____________Distance From foundation____8�__________.Material ___ mr1t--�bT' C t No. of compartments-------------9----------Size--k!_x4�-x t------Liquid depth_-_1-&-t-----------Capacity---8 0 ------ r Q� t 3 Disposal Field: Distance..from nearest well ___ _______-__.Distance from foundation___________________Distance to nearest lot line---5_____-______ Number of lines--------I_-_-�ock___------Length of each line------------_�-------------Width of french------------��-------------.._-- Type of filter material-_ ___________________Depth of f+l#er m erial_ --- -____ 0 }!, ► Total length Jr Seepage Pit: Distance to nearest well---SO-------------Di enc e from foun ation____Z9__........Distance to nearest lot line---1.__________ [ i Number of pits--- _�______________Lining m terial__b��_��____ .Size: Diameter----3-1---------------Depth_:r______-___________:_____ E Cesspool: Distance from nearesfi well_________________Di fro unda tion_-_-_________--___.Lining material____-____________}-________________ !� ❑ I Size: Diameter-_J--------------------- -----------Depth------------------ ---------------------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well---------------------------.---------------------Distance from nearest building______-________---___-________--_______. ❑ Distance to nearest lot line__________________________________________4-" --------------------------- Re deting and/rd' repairin .(describe]:_____._- BW By8t3i� ' - ---------- ----- -------- -- rte_-% �__ - --------- I� -- e --------, ° ----- ----- ------------ ------ - ------ ------------ - ----- a---------- -------------------- --° ------- ------- -------- --------- - ---- -- ------------------------------- I .hereby certify that I have prepared this application and that the work 'I be one in accordance with San Joaquin County ordinancesoState laws, and rules and regulations of the San Joaquin Local Health District. _ Del ---------•------ = (Signed) . ----------------(Owner and/or Contractor) By: P err War�14_--A;1_(-- an Y•--------------------------------------�-:-:------------------- - ---'- - -----------`----------- ----------------------{Title')------Otn�11��'—M�,x'-'------ -----` (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY Z APPLICATION ACCEPTED BY3 --------- ---------------------------•-------------------------------------------------- DATE I . _. BY REVIEWED ---=---- ------ --------------------------------------------- ---------------------------------- DATE------------------------------------------------------------ BUiLDING PEERR MIT T ISSUED ----------------- -------------;--------------+----------------------------------- DATE - Alterations and/or re mmendations:,= - - -- --- '- - ---------------------•-------------------------------i ---------- ------------ --- - .-,� _�..... F Y _-------------------------------------------------------------------------------------------------------------------------------------------------------------- i ------------------------_---------------_------------------------------------------------------------- i_________---________________________ __-__-_______-__--____ ti FINAL INSPECTION BY:_----- c ---------------------------------------------------f Date------- ! SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Sfraet 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California 11�1 Tracy, California U E —4-2M 8-51 Revised W-2100 40