13 - Laserfiche WebLink

Home Browse Search

i h � APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Application 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. .B JOB ADDRESS AND LOCATION �a_6------------- --------- --- ---- --`�-------------------------------------------------------- / Owner's Name----Q-6__t1.4L/-------- ----------------- ------------------------------------------------------------- Phone__ S-r "• Address -----------�----9'p- :. -'�-�t +�'------ "�.-----------------------------------------•----------------- - >0, ' f- " Contractor's Name el`r.! --------------------------------------- --- Phone_ . ` ._. Installation will serve: Residence Apartment House E] Commercial ❑ Trailer Court [-] Motel F] Other ❑ Number of living units: [ ] Number of bedrooms Number of baths 14 Lot size----J _____ __1_D_ _---_______________________ Water Supply: Public system Community system ❑ Private E❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobev Hardpan ❑ TYPE OF'INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) VZS S �c.xaiZk: Distance from nearest well_________________Distance from foundation--------------...__.Material_-__________________________________________. No. of compartments--------------------------Capacity-_---------------------Size-------------------•------------Liquid depth----------------------- Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material____________________-______________ Size: Diameter--------------------------------------Depth---------------------------------------------------- Pri* Distance from nearest well-------------------------------------------------Distance fro Barest building_________________ ,,. Distance to nearest lot line------------------------------------------------ ~�+ Seepage Pit: Distance to nearest well_l n ___Distance from foundation____ _____!_.___.Distance to nearest lot line---/A----___. Number of pits_______:___________Lining material__ Size: Diameter---92__JR&Depth_-___C Disposal Field: Distance from nearest well------------------Distance from foundation--------------------Distance to nearest lot line.__-________ ❑ Number of lines___________________________________Length of each line------------------------------Width of french------------------------------ T _--____________________________.. Type of filter material-------------------------Depth of filter material_______________________ Remodeling and/or repairing describe):----. % /61�_ -_,� --- ----------------------------------------•---------------- --------------- --------------------------- ------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------- 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. Signede- F ( 9 ) ---/'�----- ----- 4-, ------------------------------------------------------------- ------- (Owner arid/or Contractor) By: -- '„- _ f- ----f- a�l"--R--'------------------------------------------------------------------(Title)_ -_- ------- --------------------------- (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application), FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------J= 'L --------- DATE------- U- s-------------- _----- R9VIEWEDBY------------------------------ J • L ------------- DATE----------- s�------------------- BUILDING PERMIT ISSUED 7? c- --------- - ------------ - BATE Alterationsand/or recommendations--------------------------------------------------------------------------------- -------•-------••---------------------------------------------------- ------------------ �. --•------------------------------------------ --------------------------------------'--------------------------•----------------------------------------------------------------------------------------------------------- __ ISSUED____` �1t_`5_�-____-- Dafe FINAL INSPECTION BY:____ PERMIT No..---.��-------- - ----- ---- � � -- --- -- - -• r -------------- Date---------------!_�-- -.� _ � ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9--2M 9.50 W=1639