185 - 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 herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION------- L ____ ________ - ------------------------------------- 5 n 47 IL Owner's Name 0L__, ---------------- Phone- --- -- ----------- --- - --- ------ •----- Phone__ - - Address-----------------------=-- ----------- Contractor's Name--------------------------------------------------------------------------- --------------------------------------------------------------•-- Phone----------------------------------- Installation will serve: Residence 14 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms Number of baths U] Lot size-------!4,0.j.... ................. Water Supply: Public system (gf Community system ❑ Private ❑ Character of soil to a depth of/3"feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam❑ Clay ❑ Adobe,0 Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if pu lic sewer is available within 200 feet.) Se ti Tank: Distance from nearest well. Q_.._.._.Distance from foundation__ Material_ ._______. _.___. No. of compartments____________ _-------Ca Capacity -------------Size_�!-: � __57-------Liqu .d.?e�pth.•_. v" Cematerial ---_-�-___•_-_-_-_-.-_.- _- sp L• Distance from nearest well....r,6-____Distance from foundation____________________Lining material____-__-_,__-_.--.__.-_-___•----___: 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-,---___--_--_-_- ❑ Number of pits......................Lining material-__-_--_-__-_______Size: Diameter_...-------------______.Depth_______--___-------•__-____----_ i I Field: Distance from nearest well_._�.Q...__.Distance from foundation_._._.�________Distance to nearest lot line---. _.___... Number of lines------------ ____ _Length of each line ./. ---____-.Width of trench......... .................. Type of filter material._ _...._Depth of filter material._...., Remodelingand/or repairing (describe):.......................................---------------------------------------------------------------------------------------------------------------- -------•------••-------------•---•-------------------------.----------------------------------------------------------------------------------------------------------•------------------------------------------------ --------------------------------------------------------------------------------------------------------------------------------------------•------•-----•-----•---------------------------------••-----------------•-•--•- I hereby certify that I have prepared this application and that the workwill be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)-------- ..✓ ---- ----- ----- = - - ------------------------------------------------------------(Owner and/or Contractor) By:--------------------------------------------------------------- ------ (Title By: plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY.......................- --- -------------------------------------------------------- DATE----------- A REVIEWED BY--------•----------------------------------------- ----- -- ( -�-r --�------ --- ---------------------------------------------------------- DATE----------------- ------------- ----------------------•--- BUILDING PERMIT ISSUED-------------- ------- -----FPO --------- t----------- DATE----- ------• -- ------------- - Alterationsand/or recommendations:----------�.......--=--------------------------------------------• ---------------------------�..-•------ -------•---------------------------------- - -��--is'T ! '^� 1��-- �-a---------- -------,��i-- -:::::_-r'c�-------- ...----p. -j' ------------- -- �. -----•---•--••. . - - : PERMIT No.J!_�.......... ISSUED.11�- 1`. 2- _.-_�.___..._.._.(Date) FINAL INSPECTION BY______________ -/--- ---------- ----------............ Date..................... - / --- ....................... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W=1639