Laserfiche WebLink
- i <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) <br /> Application is hereby made to the San Joaquin Locai Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION---------------- ----------------------------------------- <br /> _ - <br /> Owner's Name------------------------ - IV pt__-----"" /� . � <br /> -------------------------------�-�- - ----------•---.---------------- ------ - Phone----------------------------------- <br /> Address--------------------------------------------- <br /> ----- - - ------------ <br /> Address--------------------------------•----------- l,/-. -Cro 0-4-1---� G F <br /> --------------------------------------------------------------------------------- <br /> Contractor's Name-------------------- -- ---- ------ Phone----------------------------------- <br /> Installation will serve: Residence Apartment House E] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units- . Number of bedrooms �. Number of baths [� Lot size__ ________ '_X_�_�- f <br /> Water Supply: Public system ❑ Community sysfem ❑ Private B t <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ 1\ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic,Tank: Distance from nearest well_________________Distance from foundation--------------------Material______________--_____-__--___________-________- <br /> No. of compartments------------------- -Capacity ------Size_-------------- _---_Liquid depth------------------------- <br /> C o om nearest wellO�S�• '.- oun a ion _________________ min ma er ^� <br /> Size: Diameter-- -----------Depth------ -- ---- ' <br /> Pri Distance from nearest well________________________________________-__-__Distance from nearest building________.__________- _--- __--_-_. <br /> ❑ Distance to nearest lot line________________________________________________ <br /> Seepage Pit: Distance to nearest well____________________Distance from foundation--------------------Distance to nearest lot line--___________-___ <br /> ❑ Number of pits----------------------Lining material---------------.-------Size: Diameter------------------------Depth--------------------------------- <br /> Dispos�l Field: Distance from nearest well�64�_.Distance from foundation________________.Distance to nearest lot`,(ine_________________ <br /> {+� Number of lines_______________ Length of each line_________` ________-_.Width of trench___Z�kl-_____________________-_ <br /> Type of filter material____ --------Depth of filter material-_-__----------------- <br /> /&- <br /> -1 ----__-,_/&- /may <br /> Remodeling and/or repairing (describe):------------------ ---------------------------------------------------------------------------------- --- --- <br /> - - <br /> . --_--------- _ � <br /> ------------------------ <br /> - ------- - - - <br /> � - <br /> ---------------------------------------------- ----------------------------------------------------------------------------------------------------------•-------•--------•---------------------------------------------- <br /> hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed) --------------------------- <br /> By:._ <br /> --_--.(Owner and/or Contractor)- - <br /> B • <br /> (Title)_ <br /> (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be fled with this application). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--- G6 ------------ DATE_ r=`►t <br /> s <br /> ---------------- <br /> el <br /> REVIEWED BY ---------------- DATE------------------- <br /> BUILDING <br /> ------------ ---BUILDING PERMIT ISSUED------------------------------------------------ ------ ------------------------------------------ DATE------------------------------------- <br /> 14 <br /> Alterations and/or recommendations:'___._�_____-___ _-1 ___ _-. - 1-. TiQ_ ____C�!__ <br /> ----------- <br /> ----------- A)..f---P-I_l.r?.- -------------��� '� -��- •-�-� -� ----------------------------------------------- ---- <br /> ----------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------_.. <br /> -------------------------------------------------------------•-----------•--------- ----------------------------------------------------------------------------------------------------------- <br /> PERMIT No---------5�q--------- ISSUED------ . -°--- ----------(Date) FINAL INSPECTION BY:-------- --- -- --------------------------------- <br /> Date------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES--9-2M 9-50 W=1639 <br />