5250 - Laserfiche WebLink

Home Browse Search

i' APPLICATION FOR SANITATION PERMIT JT ° Y �- (Complete in Duplicate) t7 I Application is hereby made to the San Joaquin Local Health District for a permit to construc`t� rid install the work herein described. This application is made in compliance with County Ordinance o. 549. Y JOB ADDRESS AND O ION ---- = Owner`sNa �j : _ °; �` ------------------------------------------------------------------------------ kAddre .--------- --------------- - = Contractor's Name -�`---- ------ ----- - Phone - ---/ Installation will serve: Residence Apartment Ouse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms [p Number of baths Lot size_ ; -_ � _____________________________ Water Supply: Public system Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ' Hardpan ❑ f / � 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: nearest wellDistance from foundation____- Lining material-------------------__________--_---. Saxe: Diameter_ ---------- W ---Depth---------------------------------------------------- %A Ur r Privy:., _ Distance from nearest well------------------------------------------------Distance from nearest building---_------_-_-___---_______._____-_____. ❑ f Distance to nearest lot line__---------------------------------------------- ------ _________________ ___________ i Seepage Pit: Distance to nearest we{I '-------Distance f m fo dation--- �----_-.Distance to nearest lot line-___ -�___ ,. Number of.pits------ ____________Lining materia Size: Diameter._--._, _---____-_--Depth__ 'fi____---_--____ DisposalField: Distance from nearest well------------------Distance from foundation--------------------Distance to nearest lot line_-_-___-----_--_- • Number of lines-----------------------------------Length of each line------------------------------Width of trench-------------_--------------------- i Type of filter material-------------------------Depth of fil eP material---------- -------- Remodeling , 'j Remodeling n /or epairing {describe -------- , - ------ --- - --------------------- - --- --------- --------- ---------------------- ---------- ---- --------- ---------------------------I-------------------------------------- 9 -- --------------------------------------------� ?`•�- --- - ---- --------------------- --------------------------------------- ---- ------------------------------ , reby certify that I have �epared this application and that t work will be done in accordance with San Joaquin County ordinances, Sta aw and:r, s regulations�f he San Joaq Local Health District. (Signed)------------ ------ -- -- ---- ------ - --(Owner and or Contractor) By:----------------- r I------------------------------------------------------------------------------------(Title - (Plot plans, showing (i a of[of, ocation of system in relation to wells, buildings, etc., must be`fi[ with this applteafior ' FO -DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------------------------------------- DATE-------------- ---`----- � REVIEWEDBY------------.-_- - - -------------------------------------- DATE----------------------•-------------------------------- - -------- ------------------------------------------------ - -- BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE -- ---------------------------------- Alterations and/or recommendations-------------------------------------------------------------------------------------------------------------- t , ------------------------------------------------------------------------------------------------------------------- --------------------------- ------------------------------------------------ ----- --------------- r' ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ -------------------- --------------------------------------•-------------------------------------------------------------------------------------------------•--------------------------------------------------- -- ' ---------------;-------------------------------------------------------------------------------------------------------------------------------------------- ... ---- ------------------- 9 li PERMIT No.__.r. ---------- ISSUED ------ Date FINAL INSPECTION BY:_/e / 3 Date------------------------- --- ---- ---- yi I, SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9.50 W=1634