480 - Laserfiche WebLink

Home Browse Search

y APPLICATION FOR SANITATION PERMIT u (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. This application is made in Fpmplianc with eyr)y Ordinance No. 549. JOB ADDRESS AND LOCATION-------- / f " 1� �.x-��•= � - r �t _ + Ia Owner's Name AL1. = - Phone------------------------------------ Address g�L–1-------- ^ �e^ � Contractor's Name-------------C •------------------------•--------------------------------------------------------------------- Phone---------------------------------- Installation will serve: Residence partment House ❑ Commercial ❑ Trailer Court ❑ Motel [❑ Other ❑ Number of living units: [ umber of bedrooms �, Number of baths [71 Lot size______ `Q_,X__� ________________________- 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 ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest we-ll__--_�_ «_.__._v__Distance from foundation-------------------- Material_-___ -___ 0- _ePth____? _ ---------- No. of co,m. artments____-_-__-_ _Ca acit goo ' Size �__X-4� Liquid d _____________ Cesspoo• Distance from nearest well----_-------------Distance from foundation------------------- Lining material-----------------------.-____________- ❑ Size: Diameter-------------------------------------Depth---------------------------------------------------- Privy: ------------- --Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------_------------------------ . n ❑ Distance to nearest lot line------------------------------------------------ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_-_-_-__________- +t ❑ Number of pits----------------------Lining material.-------------- ------Size: Diameter------------------------Depth---------------------------- Dispos 'Field: Distance from nearest well-----`---------Distance from foundation ----- to nearest loft line____._"__-__ Number of lines__________ __ en�gth of each line---_�o_�S_��-----Width of trench---- ____________ Type of filter material_Amr- --ift�0!Apth of filter material_________ i 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, State laws, and rules and regulations of the.-San Joaquin Locale Health District. (Signed)___.__ __ _ _ _. _______ ------------------------(Owner and/or Contractor] By:----------------------------•----•------------------------------------------------------------------------- 1--------I---------------(Title)-----------------------------------•--------------------------- (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application). r- °` 1 aw iV + FOR DEPARTMENT USE 6NLY APPLICATION ACCEPTED BY-------------------- .! �_ ------------- DATE------------ 1 ,! - t , ' REVIEWEDBY---------•--------------------------------------------------------------------------- ---------------=----------- ------ DATE------ -- J BUILDING PERMIT ISSUED-------------------------------------------------------------------------------- -------------------- DATE------ -- ------------------------ Alterations and/or recommendations----------------------------------------------------------------------•-----------------------------•----------------•-•-•----- ------------ -------------------------- ----------. --------------------------5-1 -- ------------ ---• e -- - ----------------------------�° -- -------- .-----------------------------------.- .. ----.------------------------- --------------------- ----------------------------,--II------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•---------------- PERMIT No-------T0_------ ISSUED------ -'- ti_' �----------------(Date) FINAL INSPECTION BY:.-----------0-4-1--- --- Date-------------------------- ' /�-Ir 1 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W-;3639