170 - Laserfiche WebLink

Home Browse Search

.. � l � 41 i APPLICATION FOR SANITATION PERMIT F. (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 Ordinance No. 549. J08 ADDRESS AND LO ATl��/,y��ry x4 ' �, ---- .----- Owner's Name------JE-A--U'-----1,- Address---------------------------19�+ i ----._— ------------------------------------------------------ tea.:-- __ Contractor's Name--.--__- -4—9—L- _tom-Ai_ _.__ 2-C„ --------------------- Phone--- .-`a'� • -- Installation will serve: Reti --- Residence A Apartment House '� p ❑ Commercial ❑ Trailer Court ❑ Motel .❑ Other ❑ Number of living units: [A Number of bedrooms Number of baths ® Lot size---------- ______ _, r � --------------------- Water Supply: Public system6Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobelm Hardpan on. TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) "V Septic Tank: Distance-from nearest well-----------------Distance from foundation--------------------Material No. of compartments--------------------------Capacity-----------------------Size-------------------------------Liquid depth------------------ ------ Cesspool: Distance from nearest well_________________Distance from foundation------------------ Lining material_______________--a___- Size: Diameter-------------------------------------Depth---------------------------------------------------- I Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---------------------- --------------------- El Distance to nearest lot line________________________________________________ SeeWe e Pit: Distance to nearest well__&&-AJ/-----Distance from foundation---'7__ --------Distance to nearest lot line--- Number of pits--------l____-------Lining material-__-�_ __._-,�- .Size: Diameterj,�-_--Depth____-&-Q_ ______________ • D ❑osa Field: Distance froof m nearest welles ----------------Distatn�ceofrom foundation______-_________`.Distance to nearest lot line--__________-____ p Length each.line Width of trench Type of filter material__________ _____________Depth of filter material----------------------- Remodeling and/or repairing describe --- ----------------------------------•-----------------------------------= ------------------------------------------------- ------------------------------------------------------------- - hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St a flaws;�7i�rub- and regulations of the San Joaquin Local Health District. 1,- -__ F__ _'_.. (Signed) f? rt° �----------------------- -- - --------�-------- - - - --- - Contractor} * ----------------------------- ------------------------------------------------------ Yitle ( f11 -------------- (Plot P&' , sowing size of lot, location of sy em in relation to wells, buildings, etc., must be filed with this application). _ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---------------- ------------- DATE �l� 27 --------- -REVIEWED ------------------ BY------------------------------------------------------- ------------------------------ ------------------------------------- DATE--------46 2-7',5 -------------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE - Alterations and/or recommendations:-------------------------------------------------------------------------------------- ------------------------------------ 4 --------------------------------•----------------------•------------------------------------------------------------------------ ---------------------------------------------------- PERMIT No-1-2-a------------- ISSUED-'___!