Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
a : APPLICATION FOR SANITATION PERMIT <br /> /-42l D (Complete in Duplicate) <br /> Application 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 /> _ <br /> _ 4- --- ------------------------------------------------�-` <br /> JOB ADDRESS AND LOCATION------------------------------ ------- - <br /> Owner's Name 1 ► ff% _ R�- `----------------------- -- Phone= T= -�= ' ------ <br /> r� «l <br /> Address-----------------•- 1,44 IV, ' L(Vf t�f_A, -----------°��----�'�.-f--------------------------- k <br /> Contractor's Name------ ` ' �� � _t l-/ --- -------------- ---------. _ f__-------------------------- Phone ---------------------- <br /> Installation <br /> ------------_- - <br /> Installation will serve: Residence _R Apartment House ♦] Commercial ❑ Trailer 'Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ❑. Number of bedrooms p, Number of baths FL] Lot size_____'�+� - __ ---- ...........----------- <br /> Water Supply: Public system Community system ❑ Private ❑ <br /> Character of soil to a depth of i3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <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 /> ❑ Size: Diameter--------------------------------Depth----------------t----------------------- - <br /> - ._ . _ . <br /> Privy: Distance.from.nearest well =_-_-__:-_ ____________________________Distance' from nearest�buiiding----.__________________________________ <br /> ❑ Distance to nearest lot line________________________________________________ <br /> Seepage Pit: Distance to nearest-well___,r�_ ____Distance from foundation"-='? +. __.Distance to nearest lot line-- :m7--_ <br /> Number of pits__ _____,__Lining matecial: :__'k_'_____Size: Diameter_=� ' "--_______.Depth:_._.ffi _________________ <br /> _...Disposal Field: Distance from nearest well---------------------Distance from foundation--------------------Distance to nearest lot line_________-_____- F <br /> ❑ Number of lines-----------------------------------Length.of each•line-------------------------_----Width of trench----------------------------------- <br /> Type of filter material-------------------------Depth of filter material--------------__--- <br /> r�1 <br /> Remodeling and/or repairing (describe:-'---- --- ------ r"' '�-------------- <br /> �a �, - �- t <br /> --•-------- --- --- -------- -------•-------- -----------------`- - ----- -- ------- -------- <br /> ------------- <br /> - 1s <br /> --------------------------------------------=---=-----— --------------------------------------------------- <br /> f/ <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 laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed------------------ - -------------- -- -- Owner and/or Contractor <br /> B . �1 l 'I; -_�' f�` � � � a f`..{ Tit j1-ell �i� <br /> ` • G a rr 3 <br /> By - - -----------�_; - ------ --- — - ---------------- )� d <br /> (Plot plans, showing size of lot, location of system in.relation+o we[is,.buildingi. a+c., must be filed'with ,this application). <br /> - <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------------------------------------- > - DATE- <br /> -------- <br /> REVIEWED BY--------------=-------- --------------------- - -- - DATE ------/__--- ---- <br /> BUILDING PERMIT. ISSUED------------------------------------------------------------------------------------------------------ DATE---------------- <br /> -------------------------------------------- <br /> 1 Alterations and/or recommendations--------------------------------------------- --------------------------------------------------------- <br /> ------------------------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------- <br /> ------------------------------------------------------------------- - <br /> ------------------------------- ----------------------------------- ----------------------- «. <br /> �__ i <br /> �4 PERMIT No----3_�6----------- ISSUED------3_—/�---�------------(Date '�Com.- <br /> FINAL INSPECTION BY:----------- -,------�Z�"--------------- <br /> -------------- <br /> Date------------------- ��'f--------- ------------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> '� 1=5-4-2M 9-5fl W-1b39 <br />