107 - Laserfiche WebLink

Home Browse Search

14, APPLICATION FOR SANITATION PERMIT `1 (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 compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION-------37A---------- Owner's Name----'=s ='' 3'* p.rn�.1,'------------------------------------------------- --------------------------------------------- -------------- Address---------------- -' = ----------------------------- Contractor's Name-----_ _ ----- ------ Phone----------------------------------- ------------------------------------------------------------------------------------------ Installation will serve: Residence [2,• Apartment House E] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ❑ Number of bedrooms Q Number of baths --------------------- Lot size_____ _ _ ___________________ Vl! Wafer Supply: Public system ❑ Community system 0 Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ 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 well--5t)---f---Distance from foundation-19 ---!! _r.Material-__ _rr-70nd-__y____________________ � _________-- -----U1 No. of compartments-`------,__�------------Capacity_' ---!"�_ Size-T---`' - _ Liquid dep th . Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_------_____-_________-______--____._. ❑ Size: Diameter---------------------- ----- --------Depth---------------=------- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building____-______._--.___--_--_-_---_---__.--. ❑ Distance to nearest lof line------------------------------------------------ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to'nearest lot line----__-------,_. ❑ Number of pits----------------------Lining material------------------------Size: Diameter-----------------------Depth--------------------------------- Disposal --_______________--________ ---_Disposal Field: Distance from nearest well-5P---P!?Distance from foundation-19---ft'-_Distance to nearest lot line---- ___ tk, [] Number of lines______________ ------- Length of each line__�if f ��Width of trench______ - --'--------------------- Type of filter material-a'' 4G _-------Depth of filter material______j_ie.f_'__..___ Q Remodeling 'and/or repairing (describe):---------`---------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------•-----------------------------------•------------------------------- I --------------------------------------------------------------------•--------------------------------------------- i ------------------------------------------------------------------------------------------------- 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 rules and' regulations o, fheNSan Joaquin Loc H Ith District, i 3 ` (Signed)------------- -- ------- ---- ---- - ------ - ------------=----------- -----,--------------------------------=---------------(Owner and/or Contractor) ----------------------------------------------------=------------------ Title (Plot plans, showing size of lot, location of system in relation to wells,, buildings, efc., must be filed with this application). I IE FOR DEPARTMENT USE ONLY 1 APPLICATION ACCEPTED BY_-VjV l"�------------------------------------ --------------------------------------- DATE-------- 1-1----�'- "r---o----------------------- REVIEWED BY------------------------------- ----------------------------- ----- DATE------ ----------------------- BUILDING ---------------------- BUILDING PERMIT ISSUED-----------------------------------=--= 5 � - D AV------------------------------------------------------------- Alterations and/or recommendations:----------------1----- - ------------------------------------------------- ------------------------------------------------ ---------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------ - - -------------------------------------------------------------------------------------- PERMIT No.__l Q_. ---------- ISSUED----- //-__�---- -------(Date],, FINAL INSPECTION BY:------.-- .---v--4 PERMIT ..J Date-------------------- w ---- I SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W=1639