Laserfiche WebLink
_�~ ;L <br /> APPLICATION FOR SANITATION PERMIT <br /> (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 /> JOB ADDRESS A N__- <br /> LOCATIO �J_/__------- {=� --------- <br /> -- ---�-_t7----- -------�i__�_�-'�=-------- -------------------- ---------- --- - ----- <br /> Owner's Name-- /�, �. �-t .�� Phone <br /> Address_!___� -_-_ __ <br /> Contractor's Name--yF1?--t- 1 � - - --------------------------------------- Phone__9`�7X--Q_L_ <br /> Installation will serve: Residence N� Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: [�] Number of bedrooms Number of baths ¢] Lot size----- _r __ �7 `_________________ <br /> Water Supply: Public system' Community system ❑ Private ❑ <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Cfay Loam ❑ Clay ❑ AdobeX Hardpan ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> f f ' <br /> Septic Tank: Distance from nearest well__ _6_____Distance from foundation-----Is __-__ Material-----a�w <br /> XNo. of compartments---------,_?–----------Capacity--p1.10---------Size_J�I-X.?L--------Liquid 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 to nearest lot line________________________________________________ <br /> Seepage Pit: Distance to nearest wellI-�f C_`__Distance from foundation--/ __.Distance to nearest lot line--- <br /> Number of pits---__-./------------Lining material__jii Ate--Size: Diamefer__271 .........Depth------_26'__ <br /> -------------- <br /> .Disposal Field: Distance from nearest weH__-j9�.0__'_____.Distance from foundation-_ 7_0-_____-Distance to nearest lot line___3_r_�_f__ <br /> Number of lines---------_I_-__�--�--------------Length of each line-------..,i-p__�-----____--Width of trench-----,?- ------------------ <br /> Type of filter material_) Pot- Depth of filter material _______/_J�1_101___ <br /> Remodelingand/or repairing (describe)---------------------------------------------------------------------------------------------------------------------------------------------------------- <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 laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Sign ed)---#: A......... Gi-'1�I1€'��� �u` �------------------------------------------------------------------------ZLCWa+wp <br /> rd/or Contractor) <br /> - <br /> BY:---- ---------------- ----------------------------------------------------(Title t�� <br /> (Piot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ----- ---- �Z <br /> -- <br /> ---------------------------------------- DATE------------- _ ------------ <br /> REVIEWED BY - -- - ----------------- DATE ----- ---- ----- --------------- <br /> BUILDINGPERMIT ISSUED--------------------------------------------------- ----- -------------------------- -------- DATE------------------------------------------------------------ <br /> Alterations and/or recommendations: <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------ <br /> PERMIT No.�S. --------- ISSUED---- -.2-- �,5`I.--------(Date) FINAL INSPECTION BY:----W---V-1 <br /> Date-------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-2M4-50 W-1639 <br />