Laserfiche WebLink
APPLICATION FOR, SANITATION PERMIT <br /> in Duplicate) <br /> (Complete p ) <br /> Applicat`ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. 4� <br /> This a 549. <br /> 'pp is made in compliance with County Ordinance No, Y <br /> fJOB ADDRESS AND LOCATION---------_-�x---1 -- hrQniol.q---Aver-----Stockton---------------------- - <br /> Owner's Name-------------------'-- ----------------ANNA---HELM------------------------------- <br /> - --- ----------------- ------- ------- - Phone----3----•---�-------- ------- <br /> Address---------------- -9 5---NQ•---San__joagUjn__qtreet.-•----------------------------------------------------- ----------------------- <br /> -------------------- <br /> --- - Phone-----�"_'96Q'�-----•------ <br /> D .A. PARRISH-_&--SOT?5� -ZNC. ._ ------- -�------------ ------ � <br /> Contractor's Name--------------------------- '-- <br /> A Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Installation will serve: Residence:E p <br /> Number of living units: Mpumber of bedrooms ® Number of baths ER Lotksize---__ -- ---- - <br /> Water Supply: Public system] Community system ❑ Priva#e E] <br />° Ch <br /> aracter of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam El Clay Loam ❑ Clay ❑ Adobe[X Hardpan E] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> i <br /> p c Tank: Distance from nearest well----- Distance from foundation____________________Material------------------------------------------------- <br /> Septic depth-_________-___________-Ii <br /> 0�EX1.St1.r1�°- of compartments--------------------------Capacity-----------------------Size------------------------------ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining materia____-___--------------- -- <br /> r --------- <br /> ❑ Size: Diameter--------------------------------------Depth---------------------- ----------------- <br /> Distance from nearest building --------------------Distance from nearest well_________________________ - g"Privy: - <br /> -----------Distance to nearest lot line--------------------------------------- -- -- 1Seepage Pit: Distance to nearest well--_NOX e__-----Distance from foundation__-__1-�___----.Distance to nearest lot line____ _________.3_.---------------Depth-----20 t------------------- , <br /> Number of pits____-_�-_____________Lining material-_�%�___Bz'1C�ze: Diameter_ <br /> Disposal Field: Distance from nearest wel4___--Nane-Distance from foundation_____Lf�________-.Distance to nearest to line_________.____ <br /> Number of lines-------------I----- -----------Length of each line_----------- Q -i�-----.Width of trench--- --2"_tt_-_-________" <br /> s "-__-_Depth of filter material__-_-___I$-----_--- <br /> Type of filter material Rx����- <br /> I}ra�.na e__o�f'___exst_in se ��c_ e�ss oll combo. <br /> g <br /> Remodeling and/or repairing (descrkbe)____________ ________ " ---"__"_ <br /> ------------------------------- <br /> - -------- <br /> ! her 6y--cee i t at I have <br /> es prepnd ared <br /> this <br /> ons application <br /> the San Joaquin h work <br /> Healbe th h Dis ne n accordance with San Joaquin County <br /> ordinance , <br /> �1S ThTC,� ---- ------'--------------- <br /> (Signed) <br /> -------------- Contractor) <br /> (Signed)--- D-_ SRR & s <br /> Il ---- Title......Es t oma- © ' <br /> gr ---- -`------------------- - - ----=--- -------------------------------- (Title) <br /> --- -- --------- - _. <br /> (Plot plans, s v ing size of lot, IOCattOn of cyst in relation wells, buildings, etc., must be filed with this application). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--- ------------------------------------------------------------------------ DATE <br /> DATE -f <br /> REVIEWED BY---------------------------- <br /> BUILDING PERMIT ISSUED------------------------------------ ------------- <br /> Ai+erations and/or recommendations---------- ' - ► <br /> �> ---------- <br /> --w <br /> ----------------- -- --- <br /> --------------- <br /> -------------------------------------------------------------------- <br /> ---------- ---------- <br /> 11---- -------- <br /> ---- <br /> ----------------------- -------------------------------------------------------------------- <br /> -------------------------------------------- <br /> ---------------------- <br /> Z ISSUED - '-------L(Date) FINAL INSPECTION BY:------ y <br /> PERMIT No.ficeZ . --- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> - ES-9-2M 9-50 W-1639 <br />