792 - Laserfiche WebLink

Home Browse Search

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. I This application is made in compliance with County Ordinance No. 549. I j JOB ADDRESS AND rLOCATION--E-- - -------------- ` ------ � -------r- -e----- ---------------- Owner's Name 6 � ---- Phone------------------------------------ - - �_ r _t-- � � =------ - A/V------- f1l --------------------------------------- Address ' D ------------- Phone Contractor's Name------s ------- Installation ---r Installation will serve: Residence 06partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: [ Number of bedrooms [ Number of baths E/ Lot size__- _ .___l _ _ _________________________ Water Supply: Public systemCommunity system E] Private ElCharacter of soil to a de th of.3 feet: San ❑ rave ❑ anLoam ❑ ❑ Adobe Hardpan Gravel Sandy LClay Loam Clay ❑ ❑ p � O 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--------------------Material_______________.-_-_---__________________-____. ❑ No. of compartments--------------- ----------Capacity-----------------------Size-------------------------------Liquid depth-------------------------- Cesspool: Distance from nearest well-------------------Distance from foundation---------------------Lining material_______________________________-_____.� ❑ Size: Diameter----------------------"---------------Depth---------------------------------------------------- Privy. Distance from nearest well-------__________________________________________Distance from nearest building._._._______________-______________.._-. 1 ❑ Distance to nearest lot line------------------------------------------------ 'Se ___________________ ____-_-__'See a e Pit: Distance to nearest RR�W''ell_ 0l_G(�___Distance from foundation_.- - -___.Distance to nearest to line--/ Number of pits__0!"!-��___---------Lining material.___�J�i-U/N.Size: Diameter-__-V ff-----Depth_,c L''�_____________ '~ } Disposal Field: Distance from nearest well Distance from foundation----------------------Distance to nearest lot line....____________- ❑ Number of lines-----------------------------------Length of each line------------------------------Width of trench-_--------------------------------- ` Type of filter.material___----------------------Depth of filter material----------------------- 7 R � Remodeling,and/or repairing (describe):______ ___ - ` ~ '' ---- ---- -- ---- ------- --)P is 77.0- --------- -----��_(- ------------) --R- !�----------- ------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------- -------------------------------------------------------------------------------- ---------------------- ----------------------------------------------------------------------- I hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County ordinances, State-la, s, and rules and�re—aultions of +he San J aqui ocal Heaf+h Dis#rict. (Signed}---------`------ t ;ia -- -�--f��.---------- (Owner and/or Contractor) E By:------_-------��: �---------- tx.�ra�s �Ti+le} � � ��- --------------------- (Plot plans, showing size of lot, location of system in relation o wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- ---- -- ----------------------- --------------------------=------------ DATE---- f--------------- ----------------------------------------- --- - REVIEWED BY DATE /------------------------------------- -- -------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- ' Alterations and/or recommendations----------------------------------------- ---------------------- ------------------------------------------------------------------ ----------------------------------------------------------I-----------------------------------------------•----------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------=-�J---------------------------------------- ---------------------------------------------------------------------------------------------------- PERMIT No._1___--7y-- ISSUED------7 --J_71_-J7-7------(Date) FINAL INSPECTION BY----------------------------------------------------------------- aDate---------------------------------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California I ES-9-2M 9-50 W=1639 _ - 3