424 - Laserfiche WebLink

Home Browse Search

APPLICATIONP FOR SANITATION PERMIT .41 (Complete in Duplicates 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 LOCATI N__ a-----43— �� -- --- -------- ------------------------------------------------------------------------ Owner's Name_-- _ --_-- --------;dP- -- -------- ---------------------- Phone Act Address �••^ -------tsw -----------------------�► ----------------------------------------- - - -- ---------------------------- ----------------- Contractor's Name_____ _ Phone_ ' - --4?_2---- Installation will serve: Residence Apartment House [] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: P Number of bedrooms Number of baths �t Lotsize___ r '4 o ----------------------- 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 tank or cesspool permitted if public sewer is available within 200 feet:) Septic Tank: Distance from nearest well___ d__!-_Distance from foundation_ -__---Material_-Ar No. of compartments----------- --------Capacity--�-A_'*------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-___-____-_--_____-___-__. (� ❑ Size: Diameter- ------------------------------------Depth---------------------------------------------------- Privy: Distance from nearest well___________________________________.____-________Distance from nearest bbildin ❑ Distance to nearest lot line____________________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_____---_________ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Depth--------------------------------- i T _Dis al_Field: —Distance-from ynearesi:wellaDistance .from foundatiQ____-__.Distance to nearest lot line---/ --- Number of lines_______________ Length of each line_____`_a--Q--- _:_.Width of trench___-�----______ _ _ Type of filter material _ ;r_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, State laws, and rules and regulations of the San Joaquin Local Health District. t (Signed)-----�A' .1all ----- --------------- ---------{+fir.x+ef/or Contractor) f _ ------ - - - _ 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 ACCEPTED BY---------- -- --- DATE-------_-- _ - ---- --- ------- ------------------------------- -^{�f ----------- REVIEWED BY-------------------- ------------------- -------------------- ----------------- - ---------------- --------------- DATE------------ -------------- ----------- ----- BUILDING PERMIT ISSUED--------------------------------------------------------------- -- ------------------- DATE ------------ --------------------------- Alterations and/or recommendations____________________ ------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------•--------- PERMIT N _ ------- ISSUED -�/a- /.T/------(Date) FINAL INSPECTION- Y:------ - ----- -- ---- --------------------------- Date -- ------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W=1639