856 - Laserfiche WebLink

Home Browse Search

APPLICATION N FOR SANITATION PERMIT (Complete in Duplicate) Application is hereby made to the San Joaquin Local Health District for a permit to construct r f tall they~r / rein described. This a plication isrmade-in compliance with County Ordinance No. 549- � JOB ADDRESS A CATION _ _A � ----- f fp ,r ----------------- ' jj c Owner's Name---- ------------------------------------ --- - Pne-------- _ _ � 1 Address � . - - - -- - -------------- - ------- Contractor's Name___ ------------------------- �/ ----- --------- ----------------------------------------------------- Phone- Installation will serve: Residence L pant Ouse Commercial ❑ Trailer Court ❑ Motel ❑ O}her ❑ -Number of living units: Z umber of bedrooms 0 Number of baths [ Js Lot size----{V x_ _ Water Su I Public system -- _q_--" - ---------------------------- _ PP Y� y m Community system ❑ Private ❑ - Character of soil to a depth of 3 feet: Sand ❑ "-Gravel ❑ Sandy Loam-0 —Clay Loam ❑ Clay ❑ Adobe �Hadpan TYPE OF INSTALLATION AND SPECIFICATIONS: l (No septic tank or cesspool permitted if public sewer is available within 200 feet.) W Septic ank: Distance from nearest well--�/,_________-_Distance from fof�'dation___-� _ f No. of compartments-----------fv Capacity - "l Size ' ' --� - -- - �-------- - �_Liquid depth_--__-------------___-- ( -Cesspool. Distance from nearest well-----------------Distance from foundation--------------------Lining material--_---__--_-___________-- _ --------� a ❑ Size: Diameter--------------------------------------Depth---------- ------------------- ----------------- k Privy: Distance from nearest well________________ ! ---------------------------------Distance from nearest building F 9 ------------- - Distance to nearest lot line--------------- ------------------------------- - Seepage Pit: Distance to nearest well___ - from foundation-____--_-____-_-_ ' Distance to nearest lot fine ----------------- ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------.Depth--- Dispa I Field: Distance from nearest well._:*"-------Distance from foundation- _-__-- �.N I _ Number of lines_-__--__--r:�� ,G,G- V------Distance to nearest t li - Length of each line---------7--- *-__-,1-----Width of trench - s Type of filter material_ d_'- - - pth of {filter n;iaterial------------?_-_____-__ ` } s 1 - Remodeling and/or repairing(describe):_----------------- � -. I" -%'� -- -- ------- -------------- aJf`= /f _______________________________________________________________________________-_---____-----__---__-----_--__-----_---__----_---__-----------_--------------------------__-•------_---_--------------------- 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, apd rules and4egulations of the San Joaquin Local Health District. (Signed)----- e r4.`"' — / ------------------- -----------------(Owner and/or Contractor) (PlotsY� ------------------------------------------------ ------------ ----------------------------------------(Title)---------------------------------------------------------------- # plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application). + 11 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_-________-_y_.____-_ ----------------------- -- ------- - ---- --------------------------- DATE:_ y/-- VIEWED BY----------------- ------- ----------- -------- ------------------------------------------------------------------------- --------------------------------------------- DATE BUILDING PERMIT ISSUED _____ -------------------------__-- ------------------------------------- DATE ---------------- -------------- terations and/or recommendations________________�_-_________- ---------- ------ ------- --------- ----------------------------------------------------------------------------------- --------------- ------------------------- ----------------------------------------------------------------------------------------------------------------------------- --- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- G c ----------------------- ----------------------------------- -------------------------------------------------------- PERMIT No-------- -_ --_ A A ----- ISSUED---- _-- // - ---"_-- (Date) FINAL INSPECTION BY:---_____C/___--__- �t 5 ------=----- ---------------- --- Date 2 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ES-9--2M 9-50 W-1639 Stockton, California