Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) <br /> C S 7- 2ta`f—o <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herei described. <br /> This application.is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND ATION__- ------ - -��"�ra �� __ - ''-``�r� = -----------•-rn- `-- <br /> Owner s Name----- <br /> Address <br /> n .rr :2. hone <br /> r-- ----------------------- ----------------------- - ---- <br /> Address ------------rf trtar �U ----------------------------------------- <br /> Contractor's Name.. _l --Y� v--•..�------ -------------------- -------------------=-------------------------------------------------- Phone----------------------------------- <br /> Installation will serve: Residence Motel ❑ Other ❑ <br /> - - t rrd kms, <br /> Number of living units: Number of bedrooms Number of baths Lot size_____1-_ _- /Q--�1____________________ _ <br /> Water Supply: Public system Community system ❑ Private ❑ "` ` <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe_[ Hardpan` <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: 0 <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> 1 <br /> Septic Tank: Distance from nearest well---- Distance from foundation___/�el_____.--.Material____ ��-1ct�..__ <br /> --------- <br /> No. of compar#menu__.__,,,__----------Capacity__,X�- _��__-Size__ ��+�-X�iquid depth____ ________. , <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material____________________________ - <br /> Size: Diameter--------------------------------------Depth--------------------------- ------------------------ {� \ <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------"'`---------------- -------- <br /> Distance <br /> -----_Distance to nearest lot line________________________________________________ <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line---___________ <br /> Number of pits----------------------Lining material-----------------------Size. Diameter-----------------______.Depth-------------7--__-_____-____ <br /> Di.sposal Field: Distance from nearest well__ ~_-___.Distance from foundation___-- ----_.Distance fib.nearest <br /> Number of lines___________I__________-�___.---Length of each line______ S____�-____Width of -,.�---- <br /> Type of filter _____:__Depth of filter material----__ __----__ <br /> Remodeling and/or repairing (describe):----------------------- i <br /> / � �t `J--------------------------------------------------------------- ------------------------------ <br /> - <br /> ----------------------------------------------------------------------------------------- -----------------•---------------------------------------------------------- ----------- <br /> --------------------------------------- - <br /> -------------------------------------------------------------------------------------------------------------------------------------------------------•-------------------------------------------------------------------- <br /> ------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------•----------------------- <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 ws, and rruul�es aandd regulations of the San Joaquin Local Health District, <br /> 1 <br /> (Signed)______.... (Owner and/or Contractor] <br /> By;------------------- 2 Al------------------------------------------------------------------------------ Title � .r --------------- <br /> (Plot plans, showing ize of lot, loco ion of system in relation to wells, buildings, etc., must be filed with this application}. <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----------------------------------LAJ --- ------------------------------------ DATE----- ` f <br /> ------------------------------------------------------------------------------------------ DATE------- <br /> REVIEWED BY--------------------------------- -- <br /> - <br /> BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------ -- <br /> -- ------------------- <br /> Alterations and/or recommendations----------------------------------------------------------------------------------------------•--------------------------- <br /> ! -------------------•-------------------------------------------------------------------------------------------------------------- -----•----------------------------------------------- <br /> ----------------------- <br /> t- <br /> -----------------------------------•---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> --------------------------------------------- -----------•------- - ------------1----------------------- - <br /> F <br /> PERMIT No._7Y-t---------- ISSUED------- -� - - j---- --------(Date) FINAL INSPECTION BY:-------_w_- ------------------------------- <br /> Date-------------------- <br /> -------Date-----------------------1-� ------------,------------------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-2M 9-50 W-1639 <br />