2755 - Laserfiche WebLink

Home Browse Search

y APPLIC)6-TIGN5 FOR SANITATION PERMIT ±" 't5 (Complete in Duplicate) Application is hereby made to the San Joaquin Local Health District for a permit to construct and install +he work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND O, TION -'----- - -- ------G--'---------- - ---- JI: Owner's Name -----CPIs-,ls...-- ------------ Phone------------------------------------ Address------------------ ------------------Address------------------ -----------------4E�-=--- - Contractor's Name--------------------- 7 -- --------------- Phone - r - - ' installation will serve: Residence 5L Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units. [11 Number of bedrooms CL Number of baths ] Lot size-------'�57__0---- -_-_-•__-----_____-_ Wafer Supply: Public system N Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe%g Hardpan ❑ j, 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_____ ----------Material __________ ANo, of compartments-----------�_------Capacity-----<_ --------Size----- - - - - -�--Liquid depth------- - f' _ Cesspool: Distance from nearest wel----------------- from foundation--------------------Lining material___-______-_-__ El Size: Diameter--------------------------------------Depth------------------------------------------------ Privy: Distance from nearest well--------------------_----------------------------Distance from nearest building-----------------------------------_____-. I .•❑—T=�\ Distance to nearest lot line__ _----------- -------- Seepage Pif: / Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line------- ❑ m Number of pits----------------------Lining material-----------------------Size: Diaeter-----------------------Depth--------------------- ________ � ------__---- Disposa�ld': Distance from nearest well_-'---------Distance from foundation____�d___ Distance to nearest lot line____- Number of lines________--_ _ __--- Length of each line__________-L�____-__Width of trench________' ______ ------------ Type of filter materi6lc't ,__ �--Depth of filter material _______I_Ct.......... ' �r .Remodeling and/or repairing (describe)_________________________ --------------------- ------------------------------------------ ----------------------------------------------------------------------------------------------------------•--------•---------------------------------- I hereby certify that 1 have prepared +his application and that the work will be done in accordance with San Joaquin County ordinances, to laws, and rules a d ulations of the San Joaquin Local Health District. C +ily" (Signed - ---------- -----------(Owner and/or Contractor) By:-------•------------------------------------------------------------------------- Title (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-------W_ -----/�-� - ---------------------------- ------------------ -- DATE---- - -- -��-- ----- -=-•-_---- REVIEWED BY.--------- --------- ----------- -- ------------------- -- ------------------ --------- DATE-- ------- ----------;-,----- --------"=-?-.--------- BUILDING PERMIT ISSUED--------------------------------------------------------------- ----------------- DATE- ------------------ ---------- --- ----- *' -----''-- Alterations and/or recommendations----------------------------------------------------------- --------•---------------------------------------------------------------------------------------------------------------------------- PERMIT NoA--75 ---- ISSUED------- ` ___ ____(Date) FINAL INSPECTION BY:-------- --t_____ Date---------------- ' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California B-9-2M9-5D W-1639