79 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT s (Complete in Duplicate) ';VAppl ation is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 f -------------------- JOB ADDRESS AND LOC N --------- r- �U--- -- } a �4 Owner's Name------------------- '. --------------------------- Phone----------------------------------- Address-.----------------------------------------------------------------------------------- =------------------------_------------------------------------------------------------------------------------------ Contractor's --------------------•------------------------------------------------------------------------------------------- Contractor's Name---------------------- ---- ---------- Phone----------------------------------- - - -------- --------- - Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -❑ Number of bedrooms ❑ Number of baths ❑ Lot size---------------- ----;ZRO Supply: Public system ❑ Community system ❑ Private Character of soil to a depth of 3 feet: Sand E] Gravel F-1SandyLoam E] Clay Loam E] Clay ❑ Adobe Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest weld-----------------Distance from foundation--------------------Material----------------------------------- --------____. ❑ No. of compartments--------------------------Capacity-----------------------Size---•----------------------------Liquid depth------------------------ 'Cesspool: Distance from nearest well-----------------'Distance from foundation-------------------.Lining material------------------------------------ ElSize: Diameter-------------------------------------Depth-------------------- ----------------------------- / 11 Privy: Distance from nearest well �-__----__-- __ _ istance from nearest building----- l'13-j!%------I-_6------. Distance to nearest lot line-------- i MA-VY-3a�1^____ - Seepage Pit: Distance to nearest well----------------------Distance from foundation-----_---------------------Distance to nearest lot line----------------- 171 Number of pits----------------------Lining material----------------------Size: Diameter------------------------Depth-------------•------------------- Disposal FieH: 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----------------------- ....Remodeling and/or repairing (describe):--. ------------------- --------------------------------------------------•-------------------------------- -------------------------------- ------------------------------------------------------------------------------ ----------------------------•------------------ -----------------------------•------------------------------- - - ------ -------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sfafjoaws, and rules and regulations of the San Joaquin Local Health District. L+V! W -------------------------------(Owner and/or Contractor) (Signed)---------------------------------- -- ------------------------------------------------Title (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application). i FOR DEPARTMENT USE ONLY s APPLICATION ACCEPTED BY--_---- - --------------------------------- ------------ DAT ------------- - 1 ------ REVIEWED BY--- ------------------------------- --aU = DATE------------------ 1•/ar-�� fp - --------------------------------------------------------------------- BUILDING PERMIT ISSUED--------------------------------------------------------------- ---- DATE - Alterations and/or recommendations------------------------------------ -------------------------------------•------------------------------------------------------- I --- ------------------------------------------------------------------------ ------------ --------------- - -------------------------- ----------------------------- ----------- ------------------------------------- ------------------------ ----------- - ------ ------- ------ ISSUED------ --�-� ------- DateFINAL INSPECTION BY:-------- --------------------------------------- PERMIT No..._�-- ------ - � ) Date- -------------->-=------=-- n --------------------------------•---- _.� SAN JOAQUIN L•DCAL HEALTH DISTRICT 1_ •,�)_ly -�, 130 SoA American Street J Stockton, California ES-9-2M 9-50 W=1639