169 - Laserfiche WebLink

Home Browse Search

xZ APPLICATION FOR SANITATION PERMIT (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. 54,9/gam l,p, ol- JOB ADDRESS ANP.LOCATION_.,_________ --------- ' 11 -------------------------------------------------------------------•--- Owner's Name------- -------�-- --------V-�- -1--0-�' Phone. Address----------- ---------=------ --------------------------------------;- f� Cf' -------------------------------•------------------------------------------ r�-- Name - `I.Y-1�1/ ._ l_ A 4= Phone ------------------------- Contractor's Installation-will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms ❑ Number of baths ❑ Lot size______________________________________________________________ Water Supply: Public sys+em 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: O (No sopis tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: istance from nearest well-----------------Distance from foundation -;__-_----_.Material_________________-________________------------------------------------------------ 171N�of compartments--------------------------Capacity-----�--- Size-------------------- .......Liquid depth-------------------------- Cesspool: Distance rom nearest well_________________Distane rffrom foundation--------------------Lining material____________________________________ ❑ Size: Diame --------------------------------------D --------------------------------------------------- Privy: Distance from ne est well---------.-----------------------------_________Distance from nearest building_______-__________________________ ❑ Distance to nearest line ------------_ ______________________________ Seepage Pit: Distance to nearest well____ ____ ___________Distance from foundation--------------------Distance to nearest lot line_________________ ❑ Number of pit --------------------L • g material----------------------- p p --- � -----------Size: Diameter----------------------.De th-------- ji .Dis osal Field: Distance om nearest welL____________f istance from foundation____________________Distance to nearest lot li _.-_____❑ N 11 umbe of lines............•...n:------------- Le h of-each line------------------- - ------.Width of trench--------------- -------- /Type of filter material_________________________Depth ffilter material_______________________Remodelin and or re airin describe ,11 1 �. --------------------`------- ----•_.-- - i--- -------- -----�-�_-_-- ---- - -----� -- --- -f�--------- -��----- -------------------------------------- -------------------------------- --------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joauntyordinances, State laws, and rules a d regulations of the San Joaquin Local Health District. (Signed). .. -/--'/"1 '-------L'--'--- -----� - -------------- ----- ----------- ---- {Owner and/or By:------------------------------------------------------------------------------------------------------------------------------------(Title)-------------------------------------...----------------------- (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be fled with this application). FOR DEPARTMENT 1.15E ONLY r APPLICATION ACCEPTED BY--------- ----------------------------------------------------------- DATE------- L, - REVIEWEDBY-------------------------------------- -------------------------------------------------------------------- DATE------------ __ _ f `_ BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE-------------------------------------I--------------------- Alterationsand/or recommendations----------------------------------------------------------------------------------------------------.-----------•---..------------------------------------------ -------------------------------------•----------------------------•--•-------•-------------- ----------------------------------------------------------------------------------------------------------------------•-•------ ------------------------ /�, i G__ ------------------------------------------------------------- ----- - - ----- ---- - -_�-sem-' -------------------------------•------------------------------------------------ ---------------- _____________..__-_________________________________________-__ ----- ----___----_-_._______ _ ______________._______________________._____________________________________________________________.__._. PERMIT No......'A 'I---------- ISSUED----- ---_(Da+e) FINAL INSPECTION BY-------------------------------------------•-------------------- Date-------------------------------------------------------------- -- ( SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES--9-2M 9-50 W-1639