4078 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT p '7 � �3 (Complete in Duplicate) 07 " 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 compliance``with County Ordinance No. 549. JOB ADDRESS AND LOCATION---/,;---- OCATION__-/__ 1Q.4- 6�tJ/` I - ------------- ------------------------------ -r /+ ,/ Owner's Name e��'►� ra G ___6--- --- hone---------------------- ------ ----- - Address ----- --- ------� -A.1 _.. .. ----------------------------- ---------------------- Contractor's Name------------- ------ ---- - - Phone - ---- :--------- _ Installation will serve: Residence Apartment House` mimercia T aIle rt ❑ Motel -❑- Other ❑ Number of living units: ❑ Number of bedrooms [J "V"mber of batfisE] Lot ize / HiQ --------------------- 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: (No septic +ank or cesspool permitted if public sewer is available within 200 feet.) Septi Tank: Distance from nearest well _____________Distance fro foundation----- -.Ma�teJ�'al--._,______---____-_____----- + �� r .� ?-__-Liquid depth____-- 1 No. of compartments -0d-----Size___-- _ Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material---___-__-----_-----______--___-; ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------- O Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_-__----_-------____-------_------__ i� ❑ Distance to-nearest lot line------------------------------------------------ i Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line-_: ❑ Number of pits---------------------Lining material-----------------------Size: Diameter------------------------Depth------------------- __--- -_j 1 -- Disposal Field: - Distance from nearest we!#_�_ _ Distance from_f_oundation 1:z --__-:Distance to nearest lot line-__�S , Lengt Type ubof filter material_ >� _ _We thhoff filter lmlne aterial-- Width of trench----.Z r Z f p ---------------- Remodeling and/or repairing (describe):-_--__--- ---.xa---P••c -------------•------------•------------------------------------------•-------------------- --------------------------------------------------------------------------,------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have epared this application and that the work will be done in accordance with San Joaquin Co ordinance , fe laws, and rule nd' regulations of the San Joaquin Local Health District. 1 (Signed_____ ----- -------- --------------- ------(Owner and/or Contractor) ---------------------------- BY:-------------------------------•---------------- --•---------------------------------- Title P of 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 -------------------------------------------------- DATE REVIEWED 8Y ---_- ----_-- -_. -•,+ ACCEPTED BY---------- -- ---- - - - -- - ---- ---- ----- - - DATE---- BUILDING PERMIT ISSUED ---- -_ ---- ==_-------- DATE-------------- Alterations and/or recommendations------- --117-14--1 -------------------------------------- - r _______________________________________ .: ;_ r , � : --- -------------------------------------------------_- PERMIT No------------------------ ISSUED-----------------------------------------(Date) FINAL INSPECTION BY: Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 4-50 W-1639