144 - Laserfiche WebLink

Home Browse Search

`. APPLICATION FOR SANITATION PERMIT ' (Complete in Duplicate) r 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----------I__ 8 x_ �? ��_- . (1 .� �. �- J---- (---------------- Owner's Name--------N_k-A---------rte-' 1 r ------------------------------------- -------------------------------------------- Phone----'Z'---7---0-4-- Address-- 7 Q a E �- r'' ----------------------------------- '� '� ' : • i---------------------------------------------------------- ` Contractor's Name------------- ------- ! Phone Installation will serve: Residence ©; Apartment House ❑ Commercial [] Trailer Court ❑ Motel ❑ Other ❑ `t V Number of living units: ❑ Number of bedrooms 0 Number of baths Q Lot size------- __S�_q-------x------Iq_6------------ .__ Water Supply: Public system X Community system ❑ 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: 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-------------------------------------- I] Size: Diameter--------------------------------------Depth-------------------------------------------------- Privy: Distance from nearest well__________________________________ ___________Distance from nearest building------------------------------------------ El 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 _....-----------------Dept h- -_---------------------------- �e. r Disposal Field: Distance from nearest well_________`----- ante from foundation-----/_--,&-----Distance to nearest lot line-------,r�___ Number of lines----- _____ __ _______________`L gth of each lire_________rO__.____�-_Width of french_____.2_z !_f--------------- - - - - Type of filter ma rial___1_4--- .C� _ epth of filter material______ _Q_____-_ deli g a Remodelrn and/or repairing describe ._--' C��- _________ a________ &r_•�_____��___:�,+--------------------- ---------- �__�_�''-J_____- ------- 7 ''�y • 11-1`1L - ------ t-------- t;w-------- --------- ------------- ---------------- '. _--- t , „max -� �--------------�-------------- -----------C°-2 - ---------- �" "� ` ----------- ` 'Z!_f"''v T to---!--- �--'�k !�'/ f}Arc.C� - -- -------------------------------------------------- hereby certify that I have prepared this application and that the work will 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) (Plot plans, showing 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--- /------ -------------------------- REVIEWED BY_ - --------------------------------------------------------------------------- DATE---- 1' /--- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE---------------------------------------------------- Alterations and/or recommendations---------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------•---------------_---------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------- --------------------------------------------------------------------•----------------------------------------------------------------------------------------------- PERMIT No._-/-`�`�__--------__ ISSUED-------- L_`- ---------(Date} FINAL INSPECTION BY:------- f_I.—'--------------------------------------- Date------------------------- -- ---- -- --- Date----------------------------------:--e--_---------•---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W-1639