593 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT 9 r (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 app Iication is made--Ln�comp liance th County Ordinance No. 549. 04n '73 JOB ADDRESS AND LQCATION �.� - Olt - --------- -- ------------------------------ Owner's Name___-- - � �- �---- --- -----------�� —�'_--------- - ---•--------------- - -- Phone-�----�''----'�-"-�-;� ----- Address---- 1 f ? ---------- - --------------------------- - --------------------- ------------------------ -------------------------- ---- Contractor's Nam ----- -y . �-- Phone Installation --- -- ," � will serve: Residence-,KI Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ❑ Number of bedrooms[. Number of baths V Lot size-_-- Water Supply: Public system K Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay-E] Adobe CK-H'ardpan ❑ 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---LA— --- Material_____------ No. of compartments----------2------------Capacity--- _dd--------Size----- - --- -I�-----Liquid depth---45----------------- - Cesspool• Distance from nearest well-----------------Distance from foundation-------------------.Lining material-_----______----__,___---_-____-__ El Size. Diameter---I----------------------------------Depth---------------------------------------------------- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building �y ❑ Distance to nearelst lot line_________________________--_--__-----_-_-__ Distance to nearest lot line--// ro Seep a a Pit: Distance to nearest well--------�-______Distance from f undation'7�_____----------- Number of pits----_/___---_--____-Lining material-,•-_ - -----Size; Diameter---�_�___------__.Depth_--_- Disposal Field: Distance from nearest well----- ---------Distance from foundation / } Distance to nearest lot line-_--"_�::----_- Number of lines-- --___- -- Le�,gth of each line-_-___:-�•—-�-.---___.Width of trench___:- -- a------ -A ---- , Type of filter material-___* '-tr- pth of filter material_---- ti pp a 4 Remodelingand/or repairing (describe):--------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------ ---------------------------------------`------------------------------------------------------------- •. ----------------------------------------------------------------------------------------------- J M ' - - - - - - - -- - - - - - - I hereby certify that I have prepared this application and that the kw'If be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaqu' Deal Health District. (Signed)- ------ e -- - ---r--- ----- - ------e•---------- � (Own- rand/or Contractor) By: - ---- -----------------------------------(Titl (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- - '�_ _ _. , ----------- ------------------------ DATE------- ---- REVIEWED BY ---------------------- ---------------- ------ ------------- - ------------------------------------------ DATE--- BUILDING PERMIT ISSUED----------------- ---------------------------------------- ------ DATE ----------------------------------- Alterations and or rec mendations:_ ------ ------ - --------- = r-�" _e4 __� I ` _ -- ------------- _ .w.. f A� _�! F to.�_� ,I� ,; � --__--_ _�.,'��.Via- -------------- - _ _'____-_ ------------------------ _______ ____ .. - �Y E+ li _ -----------------------------------------------o = k - _ �` 1�1 ------------ - PERMIT No0-� _ ISSUED_-____.. --- ._-5�-__ i` _(Date) FINAL INSPECTfO BY: ---------------_---_------------------------------------------- Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ES-9-2M 9-50 W=1639 Stockton, California