96 - Laserfiche WebLink

Home Browse Search

1 APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Application is hereby made to the San Joaquin Local Health District for a permit to construct and instal[the work herein described. This applicatioh is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATI N.---L-4 ----4__ � Owner's Name------ ��. ---------0�------ --------•-------------------- Phone----------------- Address-----X4_14M_2�z Contractor's Name-------0: e - lnstallation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Ej �+ Number of living units: [] Number of bedrooms X Number of baths [KI Lot size----- -._'-- _ ______________________________ Water Supply: Public system ❑ Community system ❑ Private r ` _ Character of soil to a depth of 3 feet: Sand ® Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe o Hardpan ❑ l TYPE OF INSTALLATION AND SPECIFICAT1 NS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) J Septic Tank: Distance from nearest well-' _#_41_1---- from foundation------- _r--._-.Material-- Ul-4- ---- -(_??- - No. of compartments------------ -------__Capacity____- Size9A"_)t__-3P_' Y_47'Liquid depth-------L✓ -�--___-- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- ElSize: Diameter-------------------------- Y---------Depth---------------------------------------------------- Privy: Distande from nearest well-------------------------------------------------Distance from neared building------------------------------------------ 0 ---------,__------__-_--.❑ Distanee'to.nearest lot line------------------------------------------------ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- El Number of pits---------`•-----------Lining material-----------------------Size: Diameter------------------------Dept h--------:-------.-__---_--------- � r Disposal Field: Distance from nearest well---- --_____.Distance-from foundation-------/-D------Distance to nearest lot line------ -� Number of lines------------` --------------------Length of each line-----� �.__-- ......Width of trench--------�_r- _---------------- - Type of filter materialCt•u��-J-t ,Depfh- of filter material---3--orf Remodeling and/or repairing (describe}al,__QAC.-C----I N�2 __o _-7Fri✓ -_-__ -1 -_C'L A'N- ____� .6-_____-. t �. - -- 1E'f- f" = e-�r !v � �"= � C ie�v/.1P.;v------ r -------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State awsr-•and rules and re 4rlatiogs'.of,}ie an Joaquin Local Health District. (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 (�1� _A DATE-------11� -- --- REVIEWED BY__. -° " ------------------- DATE---------/�r� '�� _. BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE--------------------------- - ------------- ------------------ Alterations and/or recommendations---------------------------------------------------------------------------------------------------------------- -------------------•--------- ----------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•---- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 1 ,.._-- -•�,...y ---------------------------------------------------------------------------------- PERMIT No--------q_ "ISSUED (Date) 'r d FINAL INSPECTION BY:--------d--------- --------------------•--------------- k Date----------------- ------------------- `._ T SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W=1639