Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT <br /> \� (Complete in Duplicate) <br /> Ap\plication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND O ATION---------.d.3k---------�_/__,�0-e"-�--'--------- vr.-" <br /> Owner's Name-------�Q 1W-----------M�_l�_ __ .lV--- <br /> ------ Phone----------------------------------- <br /> Address---------------------- QQ pw ------��---//---��------- <br /> Contractor's Name_- 1_-> t____P,9-- <br /> ------ �---------------- Phone- &JO7. -- <br /> Installation will serve: Residence 11 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motu ❑ Other ❑ <br /> Number of living units: -11 Number of bedrooms 91 Number of baths 91 Lot size____T___�_A—ze..0_�___-__--____........ <br /> Water Supply: Public system ❑ Community system ❑ Privatex <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ I ' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Material------------------------------------.--_______-_- <br /> ❑ No. of compartments--------------------------Capacity-----------------------Size--------------------------------Liquid depth-------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material______________----_-___--_--____-___-: <br /> 0 Size: Diameter-------------------------------------Depth----------------------------------------------- <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----.____--____________________-________ <br /> ❑ Distance to nearest lot line_______________________________________________ <br /> Seepage Pit: Distance to nearest well---------_------------Distance from foundation----------_---------Distance to nearest lot line-_-______-_-_____ <br /> ❑ Number of pits----------------------Linin material-----------------------Size: Diameter___.___._______---_.....Depth----------------------_________-_ <br /> t LLi <br /> .Dispo I Field: Distance from nearest we1�0--------Distance from foundation_!____-_ __Distance to nearest lot line-Alk <br /> Number of lines------0!V _ _____.___ Length of each line___WS0_ Width of trench. ------------ <br /> W <br /> __________ w <br /> rr--- <br /> Type of filter material_1 -_Depth of filter material_-/�____---_..- <br /> Remodeling and/or repairing (describe)---��t�'� ; R --------- - --------/---- -- ------------------------------•-------------------- <br /> ----------------------•----------------------------------------------- <br /> ----------------------------------------------------------------------------------------------------- --------------------------------------------------------------- ------------------------------------------------ <br /> I hereby certify that I have prepared-this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State law , and r and regulations of the San'Joaquin Local Health District. <br /> (Signed)--------- ; ���� t --(Owner d/or on#rector) <br /> t <br /> By:_----------------�+�=fes' -------- ----- - ----------------------(Title)--- - - - ----------------------- <br /> (Plot plans, showing size of lot, location of system in reW to wells, buildings, etc., must be fileAAith this application). <br /> FOR DEPARTMENT USE ONLY <br /> !U <br /> L�pq <br /> I KATION ACCEPTED BY I l- l _ ------------------------------ DATE--- -r �y �� <br /> fit/ �` 0 - _{ <br /> REVIEWEDBY------------------------------------------------------------------------------------------------------------------ -----• DATE------- ---------------------- ---------------------------- <br /> BUILDING PERMIT ISSUED--------------- ----------- ----------------------------------------- DATE------------------------------------------------------------- <br /> Alterations and/or recommendations:-----------------------------------------------------------------------------------------------------------------•------•-------------------------------- <br /> -•---------------------------------------------------------------------------------------------------------------------------------------------=--------------------------------------------------------------­----------- <br /> ------------------------------- ------------------------------------- _ - --------------- -------------------------------- -- - --- --------------------------- <br /> - <br /> PERMIT No. & ISSUED---------- ___`s__ .....(Date) FINAL INSPECTION-BY:... _ <br /> Date--------•-•--•----_--------------- ---------__------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-2M 9-50 W=1639 <br />