Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT Y 4 <br /> (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 /> s.r.. <br /> ______ ______ t <br /> JOB ADDRESS AND`LOCATION---------g a"----- ' = <br /> ! 1 ----------------------------- --------Phone �� i Q <br /> Owners Name ��, ° - ' - = _ 111 <br /> AddressA hJ_ _..;;��'.- r ------------------------------------------------------------------------------------------------------------------- <br />! l I �� <br /> ContractorsName__.---`--------- --.0-�---------------------- ----------�----- -----------�--- ----------------- ---------------- Phone----3---=-`�--�-�---- ----- <br /> Installation will serve: 'Residence [� Apartment House ❑ Commercial -[❑"Trailer Court ❑ Motel ❑ Other ❑ <br /> M <br /> I Number of living units: '[B Number of bedrooms aNumber of baths ❑ Lot-size-------- _T_r <br /> ________ _______________________. <br /> Water Supply: Public system ❑ Community system ❑ Private <br /> Character of soil to•a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe E4 Hardpan ❑ . <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------------------Dance from foundation--------------------Material--------------------------------------------_---- <br /> . <br /> ❑ Fxl +P'l No. of compartments--------------------------Capacity-----------------------Size-------------------------------Liquid depth----------------- <br /> ! • <br /> Cesspool: Distance from nearest well-----------------Distance from foundation---------------------Lining material------------------------------------- <br /> Size! <br /> -__------ __-___________---_-_______Size! Diameter--------------------------------------Depth--------------------- ----------------------------- <br /> Privy: Distance from nearest well_____________________________________-________Distance from nearest building-1 <br /> Distance to nearest lot line___________________________________________- <br /> � r ` I <br /> Seepage Pit: Distance to nearest well-- ___1_0______Distance from foundation------a Q_.____.Distan! to nearest lot line___..1�---- <br /> Number'of pits--------I______._____Lining material.-r 3 _ Size: Diameter__________Y_.________.Depth__ ' <br /> p we' ll n7 _ . , <br /> Disposal Field: Distance f�om nearest ____---_________.Distance from foundation____________________Distance. to nearest lot line________________. <br /> Number of-lines--------------:--------------------Length of each line-------------------•----------Width of french---------------------_---- <br /> Type of filter material------------_-_*�------Depth of filter material______•_______________ <br /> Remodeling and/or repairing (describe)--------------------------------•----------- __ =-- _------------------------------------------- ------- " ---------------- <br /> ` <br /> --•--------•--------------------------= - -----------L------------------------ F <br /> " -------------------- --------j_[ /1 r --------------------------------------------------------- -------�c,_—_± `"f ----`-=- `7 <br /> ---------------------------------- <br /> ----- - -------------------------------------------------------------------------------------'-------"— -----------------------------------------------------------------------------------:-------------- <br /> I 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 d regulations of the San,:7oaquin Ld'cal Health District, r <br /> --------------------------------------_{Owner and/or Contractor) <br /> ` -�-------- <br /> (Signed) <br /> t (Signed)�r• ---------------[Title) -------- <br /> i <br /> -s ----- <br /> {Plot plans, showing ae of 0 ,Notation of system in relation to wells, buildings,-efc:,-musf­be filed with this applica, <br /> FOR DEPARTMENT USE ONLY , <br /> APPLICATION ACCEPTED BY------ DATE -------- `�-------------- --------- <br /> -.REVIEWED BY----------------------------------o----�-��------------------------- ----' ---------------- DATE---- -_:---�----Ir/---------------------- <br /> BUILDINGPERMIT:I ISSUED--------�---------------=------ ----------------------------------------------------=------------ DATE-------------------1--1---------------------------------- <br /> Alterations <br /> -------------------------------Alterations and/or recommendations:----------------- ----------------- <br /> ------- -------`-------------------- <br /> It <br /> F .+_sl <br /> ------------------------------------------------------- <br /> ----------------------------------- •---------------- <br /> -------------------- <br /> --------------------------------- <br /> + > "' <br /> �� �5 ( - ---------------------------------------------- <br /> -------------- <br /> ------------------------------------ ,.j.. <br /> PERMIT No.- �___ - ISSUED <br /> k bate FINAL INS3-15 <br /> DateION BYw <br /> • � - I i <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT �J <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-2M 9-50 W=1639 <br /> ti <br />