Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT <br /> Y (Complete in Duplicate) <br /> Application is hereby made to the San Joaquin"Local 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----- `: 2 . } S=s= Caurt---st•: f 4 E: $ = <br /> ----------------------- I <br /> Owner's Name----------------Q-ha-a ----=-------------------------------------- ---------------- ---------------------- Phone--------2o----------------------- <br /> Address----------------------- 2-l-4?--a-•---C�1Is't_-� _ --------------- <br /> 4w De It a <br /> Contractor's Name -------------------------------------------------- --------------- -----------------=----=--------- ----------------------------- Phone--------3_-1'955---------- <br /> lnstallaticn-will serve: Residence :Apartment.House"❑•� Commercial .❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Dumber of livingunits: Number of`bedrooms. LNunnber' "af baths ❑L Lot-size_---fx�Z_0C---------------------------------------- <br /> Water <br /> _--- :____ __________- __ <br /> ® [� <br /> Water Supply: Public system ERCommunity system ❑. Private ,❑ <br /> Character of sail to a depth of 3 feet.i Sand Gravel Sandy Loam Clay' Loam Clay Adobe Hardpan 9 <br /> •, <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is'available within 200 feet.) <br /> J71-, <br /> ee <br /> Septic Tank: Distance from nearest "Well-----I70-------Distance from foundation------u_-__-------.Material___ ---------- <br /> ----------------- <br /> ----___- _-__:---_____------- ----------- <br /> EMT1rNG No. of compartments-----------------------------CapacitY Size--------------------------------Liquid depth--.- ---------------- <br /> Cesspool: Distance from nearest well------------------Distance from foundation--------------------Lining material- _ <br /> -------"..._------ ____-----_ , <br /> ❑ v Size: Diameter------------------------------------ Depth = - <br /> Privy: Distance from nearest well ----------- <br /> Privy: from nearest building-- _____.----- ' <br /> ❑ Distance to nearest lot line-_----------------------------_------------__ <br /> Seepage Pit: Distance to nearest well------s"------_-_Distance from foundation-----�-_____.-__,Distance to nearest lot line------ <br /> -------- <br /> :E] <br /> Number of pits------------------------Lining material--br 1C-k_----Size: Diameter-----------------------Depth--_------2-5---------------- <br /> .-Disposal Field: Distance.from nearest well------ m -_.Distance from_foundation- -_ Dis#aneeao:nearest�lot-line==___ <br /> ---- <br /> ST ING NLimber of, lines-_ ---------_ -- --- "-- Length of each line------------------------------Width of trench-------- ---------------_Type of of filter material---------------------------Depth of filter material-----________---------- +. <br /> Remodeling and/or repairing (describe):----__I2 5ter'3aJ.il1 _-n��rt_--STB-rt_iC �-__CLr_a& l__on1_y_ ----7?w----ClAs omer__--Lill . <br /> hQs k up-to---- heexistsr� `ppt-1c---tank---with.-_XJU--2-ine------------------------------ <br /> - <br /> ------------------------------------------------------------ ---- <br /> - ----------------------------------------------------------:--------------_-=•----=------------ f----------------------------- ---------------------------------------------`------------------ -------------- -------------- <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)--------- D It -------------- -------------------------------------------------------------------------------------(Owner and/or Contractor) <br /> By:--------------------- -e 'x�1 Tiarthan='--------------=--------------------------------------------------- Title --- 0"weer_-te r <br /> ( } --------------- <br /> (Plot plans, showing size of lot, location of system.inyrelation to wells, buildings, etc., must be filed with this application). <br /> FOR DEPARTMENT USE ONLY <br /> • 1 i r <br /> APPLICATION ACCEPTED.BY-- ------ --------------------------------------------- ----------------------------------------- DATE-- _ <br /> ---------------------------- <br /> REVIEWED BY- = - DATE----- <br /> BUILDING PERMIT ISSUED--:- <br /> ------------ --- - --------------- DATE------------ <br /> Alteratiqns and/or recommendations------------------------------------ - - = - <br /> ------------------------------------------------------------------------------ --------------------------- <br /> ---------------- <br /> ----------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------ --------------- ---- --"----------------- <br /> ------------------------------------------------------_-------------__------------__"_-_..---__.-.____.____------________"-----_-._-_-_____"--.-_--___ ____"__"___--___-----_------___----_______- f. <br /> PERMIT N-)__69 <br /> 7_1 ISSUED---------, `,- `� -_ Date FINAL INSPECTION - <br /> - ------------------------ "-- -- - ----- <br /> -- (Date) ON BY:---------- ------/­— <br /> Date----------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-2M 9.5U W=1639 <br />