546 - Laserfiche WebLink

Home Browse Search

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 rein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AN CATION....... ,/ _._ / _ ,/ _ __ � le..... Owner's Name �� f r = � :------ � `1 -` I Phone--` - ---�- -_ Address ,._ , Contractor's Name -------- . -- f -------------- Phone-- Installation will serve: Residence ❑ Apartment House ❑ Commercial J' Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ❑ Number of bedrooms ❑ Number of � Lot size._ r__ _- ___ ____________________ Water Supply: Public system JZ Community system F-1PrivateE] 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 wellI:tA!-------Dista9ce"from foundation__/__0 ------Material -------- No. __:No. of compartments-- �" Capacity s�' Size--,DSize-U-,Ddl id depth #----------------- T Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material-------------------------------------- EJ ____________________________-_____.❑ Size: Diameter--------------------------------------Depth--------------------------------------------------- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building____-_____-__--______-_____-______-__ ❑ Distance to nearest lot line--------------_---__------------___________._-_ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- 171 Number of pits----------------------Lining material--__ ----- ;,------Size: Diameter.......................Depth------------------_------------- -Disposal Field: Distance from nearest welh-r> .-- Distance from foundation f a Distance to nearest lot line -A Number of lines------------ ? Length of each line______ .� --------Width of trench-------ve,-- --------------------- Type of filter material.__"---_ _ ----Depth of filter material------------ ------ R®modeling and/or r pairing (describe):______ EWR '� + -4 -- --------------------------------- ......______ ••------' •--••--._ ....._-- --------••----' -'----- -------------------------------- ------------ --------- 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, s and regulations of the San Joaquin Local Health District. 4 (Signed)----. - Contractor) By:---------------- 1(1,71_- • - ( +le)(rifle) �4f 2 { = (Plot plans, showing) howing)lize 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-Y-_,�Q---=r--------------------------------------- REVIEWEDBY--------------------------------------------------------------------------------- -----------------------------------------'DATE---------------------------------------------------------- BUILDINGPERMIT ISSUED--------------------------------------------------------------------------------------- ----------- DATE------------------------------------------------------------- Alterations and/or recommendations:--------------------------------------------------------------------------------- ---------------------------------------.---------------------------- - ----------------------------------------------------------------------------------------------------------------------------------••--------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------- ------ ----------------------------------------------------- --- ---------------------------------------•--------------------••-----------------------------------------------------••--•---------------------------- PERMIT No._..�' 6______ ISSUED___ __ , --------(Date) FINAL INSPECTION BY:-------------------------��`�� Date-------------------------;/Wt)-----------------------.............. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W=1639