638 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT T 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 Ordinance No. 549. /�� '. A a4 L -------- -r JOB ADDRESS AND LOCATION ------------ ---------------------------------------------- -- --- ---.--------------------------------------------------------- --------=---------- ----------------------•--------- --------- DD ,�i G � �_� l�:J Owners Name n� # 'x Phone Address-------------------------------------------------------- "—--- -------- ----- -----------------------------------------------------------------------------------•--------------------- -------.. Contractor's Name•------------------------------- /� ?� f1 �, Phone Installation will serve: Residence je Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Rf Number of bedrooms ' Number of baths ❑ Lot size_ :'/Af F_........___•__-__ ; Water Supply: Public system ❑ Community system p Private Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan [ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: tante from nearest well-----------------Distance from foundation--------------------Material-_---__________-___:______-------____ ❑ JC)t t S�o. of compartments--------------------------Capacity Size--------------------------------Liquid depth ---.Cesspoo• Distance from nearest well•________________Distance from foundation_____-_________•___.Lining material ___-_______-__________-__ ______--- ❑ Size: Diameter--------------------------------------Depth--------------------------------------------------- Privy: ------------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----------------------- _-•-_•-_______---___ -A' , Disposal Field: Distance from nearest well___�'�__•_Distance from foundation__ ____ _______Distance to nearest lot lin -- Number of lines_......_, __ .____ •---Length of each line_-_.____ � _••-__ -Width of french...... Type of filter material_�_x_�__a!_______Depth of filter material-_________,� ___ Remodeling and/or repairing (describe):----------------------------------------------------•-------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------- 1 herebyY ck at I have prepared is application and that the work will be done in accordance with San Joaquin Count= ordinan es, Stan ules a eg f s of the San Jo qu' Local Health District. (Signed)- ° ` ------ ----'� ---- ---- ------ ----------------------------------------------(Owner and/or Contract; bye . ---------------------------------------------------------(Title)--------------------------------------------------- ---- (Plot plans, wing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------- �"'.. -------------- ------------------------------ DATE BY............ - - f ------------------------------------------------ DATE--------- ---- w , - ----------------------------------------------------------- -- BUILDING PERMIT ISSUED-------------------------------------- ------------------------- ---------------------------------------- DATE----------- ----- Alterations and/or recommendations:--------------------------------------------------------------- ----------•-----------------------------------------------------------------------------------------------•---------------•--•---•------•-•••---------------------------------------------------------•---••-----•-------- --------------------------------------------------------------------------•---------------------------------------------------------------------------------•-------------------------------------------------------------- ----------------------------------------------------------------------------------•--•----------------------------------------------------------------------------------.--------------------------------------------------- ----------------------------------9----------------------------------- -------............--------------------------------------------------------------------------- ---------------.......................... PERMIT No. _3 ------- ISSUED_._! ) �- ..�'Gt -�`-`�--•-----IDate FINAL INSPECTION BY----------------------- ------------------------------•------- Date---- � ( 4— SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ES-9-2M 9-50 W=1639 Stockton, California