907 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT rZl I (Complete in Duplicate) SlCMNE This Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work in described. County,Ordinance No. 549. JOB ADDRESS ANDdL In ATION compliance with Ord applicationP Owners Name.--.._-_.- _fQlA[ {L Address---------------------�.� �• - one-- -- - ----------------- ---- - - - -------- - - -- - -- Contractor's Name... r._. ....�...-. . 11 }�,( ��1 I._>-1 _-._�-zc_A%.5� -. 1 L°r--`--- Phone_ .-':...ISO 7 ___ _ Installation will serve: Residence x Apartment House ❑ Commercial ❑ Trailer Court �� { ❑yM�,otel ❑ Other ❑ Number of living units:? Number of bedrooms g Number of baths a Lot size.4r---K 1". s Water Supply: Public system VL Community system (� Character of soil to a depth of 3 feet: Sand ❑ y Gravel ❑PriSandy❑Loam ❑ Clay Loam ❑ Cly a v ❑ 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 well_�____Distance from foundation-/�?_'_..._Material- p ,� ,-- kr�1�Sa-----li -- ------ No. of compartments--..1' L�.r(�-_---Capacity(9{917.-6A/Siz -_d 5._ _..Liquid depth-.-�1 - Cesspool: Distance from nearest well---.---__---.-Distance from foundation-.--_-__.----.--.Lining material-__-.._-..--_..._-._-.__ ❑ Size: Diameter---------------------------- Depth---------------------.................- Privy: Distance from nearest well--------------------------------- __.--------_.Distance from nearest buildin ❑ Distance to nearest lot line-------------------------------------- g----------- ---- Seepane Pit: Distance to nearest well----- —.----_---Distance ff foundation-./V__f-_---Distance to nearest lot line-_ .........Number of pits___0&�...--Lining material__4ff 1-0,R,.Size: Diameter-..-- -- --' � Depth P a�s, --------- Number ------- -- Dispo�al Field: Distance from nearest well-_- _..Distance from foundation. - ----- -..Distance to nearest lot line...-S11 `��d'� Number l lines-tent -- � Len th of each line-- .-_-r`� T - - 9 + -------.Width of trench- 7_#-." Type of filter material -%- R9C/L De th of filter material---. - �� P Remodeling and/o /repairing (describe):_--.-.. -- ,- _ ---------------------------- a ate,- = ------------------------------------- -------------- ,��-----�- - - ---------------------- ---- - -------------------------------------------- --- - .. I hereby certify that I have prepared this application and that the Wk will be done in accordance with San Joaquin County ordinances, Sta+ ws, and rules ¢tId regulationZof a San oaquin Health District• (SignedB-- v 1� X01 (Owner and/or Contractor) - -- - --- - ------ Ys, s--ow* - i ------ 1------ into ^ ------(Ti+1e)-----(Plot plans, showing si e o lot, location of rystem in relatwells, buildings, efe, must be filed i+h this application). R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------- -- --------- --------------------------------.- - -------------------------.---- DATE------ -------- -- -------REVIEWED BY --------- ------------------------------------------------------------------------------ ------- ---------------- DATE--- --------- .. .... .. BUILDING PERMIT ISSUED -- -------- -----------_...._._--_---..-.___.-----. - ------------ - ------ ------------- -----------------Alterations and/or recommendations:------ ATE------------- .....— ------------------------- --------------------------.--.---------------------------------------------------------- --------------------------------- -------------------------------------------------------------.. ----------------------- -- ------- - --- ----------------------------------------------- ---------------------- --- -- ---- ------ PERMIT No-q-0-- -.._--. ISSUED--....__. ---------------------------------------- -.--------(Date) FINAL INSPECTION BY:-:.-- ----- --- - -------------------------_--- Date---------_----------------- -- ------�- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W-1639