686 - Laserfiche WebLink

Home Browse Search

1 APPLICATION FOR SANITATION PERMIT r! (Complete in Duplicate) Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Or 'Hance No. 549 JOB ADDRESS A 4WLO ATIO ______ -- Owner's Name---------- ' ------- Phone _" Address----I;Z-a�-- ------------------------------------------------------------------------------------ Contractor's Name---- ------------- -------------------------- ---------------- - ---------------- PhonA------- --------------------------- Installation --- ------------ will serve: Residence Apartment House ❑ ommercial ❑ Trailer Court ❑ Motel ❑ Other Cl lei Number of living units: Number of bedrooms [Number of baths 0 Lot size__�� Wafer Supply: Publics stem " PP Y� y ❑ Community system ❑ Private � L Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ©. Clay ❑ Adobe Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: r (No septic tank or cesspool permitted if u�li�cseer is available within 200 feet.) Sep tic ank: Distance from nearest well � Distance from foundation------ _' No. of compartments / -�" Ma enal _ _____ __ Capacity P Size � q _lot iquid depth__ --------- -- esspool: Distance from nearest well-----------------Distance from foundation---------_----------Lining material______________._____---_____________ ❑ Size: Diameter_____________________________ ---------Depth---------------------------------------------------- Privy: Distance from nearest well_ _ _Distance from nearest building------------------------------------------ Seepage Distance to nearest lot line __ � Seepage Pit: Distance to nearest well----------------------Distance from foundation__ ❑ Number of pits______________________Lining material_________ _ ---------"--'-'--Distance to nearest lot line_______._________ // // - -----------Size: Diameter-----------------------.Depth-------- line------- Disposal Field: Distance from nearest well -0__""Distance from foundation____ _ ❑ Number of lines_________ a---.Distance to nearesto� line________ '`-- -� ______--- Length of each line____________ Width of french Type of filter materia ........#, ,..Depth of filter material_________________._-__ Remodeling and/or repairing (describe): -------------------------------------------------------------------- --- --- - ----- ---------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I hav repared Phis application and that the work will be done in accordance with San Joaquin County ordinances,�Tf , and a d re u ions of the San Joaquin Local Health District. (Signed)---- 4. BY: ---------------------------------------------------------------------------------;- ne end/or Confractor) ------------ __ ( p g - -y - -- - ------- ---wells uil in --ef -----------(rifle)-------------------------------------------------------------- - ------------- ____________ -- - - ---------------------------------- of tans, showing size of lot, location of system in relation+o well s, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_____ __ ------------------------------------------ REVIEWED BY DATE------- cs BUILDING PERMIT ISSUED ------ DATE -----------•----------------------------------------------------- DATE--------------------------------------------- ----------------------------A terafions and/or recommends+ions_________ ___ -------------------------------- ----------------------------- ------------------------- - - -------------------- -------------------------------------------------- ....,,:PERMIT No.-Y-4 ISSUED-_-_-- --1-¢�_ _____(Date) FINAL INSPECTION BY:----- ___� _ Datel -- ---------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ES-9-2M 9-50 w-1639 Stockton, California