8293 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT permit (Complete in Duplicate) Date Issued ___� 7 Q Applica+ion is hereby made to the San Joaquin 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 ---.- C .5�s -------------------------f-�-- -I�2—L ----------------------- Owner's Name--------- - .--- ---- _ ------� ----- P one.-. • ------------ Address..,.3.!_�-� �"�.c""�-- �' `�r1 - - -- Contractor's Name -------U �7-� ------- 4 !►�,�c.:e� Phone Installation will serve: Residence �"partment I�use ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: r_____ Number of bedrooms ____�)_ Number of baths ---1--- Lot size ___-__-7_67K__.: `"Cr`___________________ 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 ardpan ❑ Previous Application Made: Yes Q--No ❑ New Construction: Yes4�1'"No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.` 11-71) 6 Septic Tank: Distance from nearest well-��___..___Distanc from foundation__,-o...--..._.Ma/terial`__ ---_ "1.-�.__--t- _____ No. of compartments __ - i p ] -----------Size----> , -'•-- -- :_Liquid depth------ice_---- -- Capacity_._ Disposal Field: Distance from nearest well d- ____Distance from foundation-----;%.'....Distance to nearest lot line_______ PQ/\ Number o7 lines-------------I_---:__.......Length of each line___�_� .Width of trench--- r r41 9 2-Y------------ Type of filter material___'_i' t Depth of filter material_.. ......Total length-------'7-_--S---------------------- 01 ________________f_ ° P e ____.Distance to nearest lot line__--_ Seepage Pit: Distance to nearest wejl_.J.L._._.___Distance from foundation_.._- _ � __.____. ,J ® Number of its_________ _----- ____Linin material-_-_--7_ kYr4-JLSize: Diameter-_75-6.. ` Depth....... m Cesspool: Distance from nearest well-----------------Distance from foundation.._.----------------Lining material--._.____..___-_______-____________-- M ❑ Size: Diameter------- ------------------------------Depth------------------------------------------------- ---Liquid-Capacity- .-------------------------gals. Privy: Distance from nearest well--------- ____----------------------------------Distance from nearest building________.____________-____-___.____._. ❑ Distance to nearest lot line--------- ------------ ----- - ------------------------------------------------------------------------------------------------------------- Remodelingand/or repairing (describe)---------- -------- ------- ----------- -----•--•••-•------•------------------------------•--•---------•----------•••----•------------------------------- ---------------------------------------------------------•-------------------------•----------------------------------------------•------------•--•-•••------•-------------------------------------------------------------- --------- ------------•------•---------------•------••------•-------------•-••--------------------------- -----------------------.....----------------------------------------------------------------------------- --------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) ----- <{Qwner and 1or Contractorl By:---------------------- 1. (Title)----- -- --• --- -_.... (Piot plan, showing size of lot, lot ion�Wrelation to wells, buildings, etc., can be placed on revers side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- ^-- ---`-------s:-----^i-:- --=••_.-.-.---------------------------•--.- DATE.----------- I - ---' ��-- ------ -------------- - ------------- rte----------------------- --- DATE---- ----- f ---------------------27 =--------- REVIEWED BY BUILDINGPERMIT ISSUED-------------------- -�----- ----------------------------•---------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:----- ------- - ---- ---- ---- --- ------- -------------------------------• -•----•--•----------------- l 1 - I -x - -- --- ----------------- --- --------- --------------------------------- ---------- --•------- ---------------------- ----------------------------------------------------------------------------------- ------------------------------------------ - ---------------------------------------------------------------------------------------- FINAL INSPECTION BY:--------- Date---�.f_� -. --------- 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 ES--9 145446 ATWOOD