17 - Laserfiche WebLink

Home Browse Search

/7 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"`x.. ' f JOB ADDRESS AND LOCATION__I_________________3229 �, Clements Ave. __� __•_ ----------------------------- ---------------S_tQ_Qkt cn----------------------- -------------- Owner`s-Name.---••-------------•------------- ---------------------------- -------------------------------. Phone-------E77524----------- - -•-------- � - - IAddress. _ .0fS t 0Ckton --- - -- i ----------- ----------------------- ------ -------------------------------------------------- Contractors Name-----------------------------_D_..�&_..---Pa_,r_-riskl--- 5_ons-s---�-UC..---------------------------------------- Phone------ ---18-5-92------------- Installation will serve: Residence] Apartment House ❑ Commercial [❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ❑ Number of bedrooms ® Number of baths ❑ Lot size-------------IQQ._X__23.5__- _.___________ Water Supply: Public system IN Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam] Clay ❑ Adobe ❑ Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation........71--------Material-____---C oncret_Q___________ _ ® No. of compartments--------•-Q1 Q-------Capacity----- �-QQ---F,.3S-2,e--- 2�� - 'D--------Liquid depth--1'Srt-------------- 3- Cesspool: Distance from nearest well---11 Z2__Distance from foundation--------------------Lining material-----------------------------_-___-_. ❑ Size:•Diameter--------------------------------------Depth--------------------- ----------------------------- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ . ❑ Distance to nearest lot line________________________________________________ Seepage Pit:. Distance to nearest well---NQUa----z�=Distance from foundation__- --_.Distance to nearest lot line--- -------- -.. f❑ Number of pits--_--- ---Lining material-----------------------Size: Diameter-------------------------Depth----=---------------------------- � Disposal Field: Distance from nearest well____ Pne..Distance from foundation----- - ----------Distance to nearest lot'line__-__ _ T _______ Number of lines--------------Ona------------Length of eachjine_�---4Qt_4`__ _*�Width-of french---2Y1_____________________ Type of filter material—Ft-oak----------Depth of filter material____-_-- 'T r - --- -------Remodeling and/or repairing (describe)= _ ----------------------------------------- ----------------- -------------------------------•------- l -- ----------- -- ----------•---------------------------------------------------------------- -------------------- ------------------------------------------------------- -----------------------�---- � = -� ------------ _ r 1 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. I (Signed) _l -�17 = ----------------------------- (Owner and/or Contractor) By:----=-------------- -- ------ --------------(Title)---------FS'_ si-d-e�.�._..------------- (Plot plans, showing size of lot, location of system in relatio to wells, buildings, etc., must be filed with this application). I V FOR.DEPARTMENT USE ONLY APPLICATION ACCEPTED BY "-= -` DATE_ REVIEWED BY ---- ------ - - ------' -----=------------------------------------------------- DATE------- BUILDING PERMIT ISSUED------------------------=4=__•___-__-_ -" 4. ------------------------------------------------------ DATE Alterations and/or recommen ations------------- -------- ------ ---------------- ----------------- -------- ----- -- Y --------------------------•--------------------------••----------------------- -------- ---•----------------- ---------------- = - : - --- _ ----------------------- - _= ---------------------------- ---�-------- ----------------- -- ----------------------------------------------------.-•------------------------------- ___.ISSUED_ _ -_ a_______.___(Date-r FINAL INSPECTION BY:---------- � PERMIT No.------��-------- r/ p--- --- ----------------- -------• I1 v (S�z Date- -----------------------/_------------ ----------------------------•-•---- SAN JOAQUIN LOCAL HEALTH DISTRICT ` 130 South American Street Stockton, California ES---•9m--2 M 9-50 W=1639