SR0078793 - Laserfiche WebLink

Home Browse Search

` ^ .,r - APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Application is hereby made to the San Joaquin Local Health District for a permit to construct an install the work herein described. This application is made in compliance with County Ordinance No. 549.' g 3 _130^ JOB ADDRESS AND LOCATION_?`- .I � c z c Owner's Name-•............. -•.............. ------------------------------- Address --•--- Ph Address _ ------ %, �. one :Contractor's Name. -- -------------- '; Installation will serve: Residence, Apartment House ............................ ---,•--.-•-------- ..................... Phone-------------------- + ❑ Commercial [I Trailer Court ❑ Motel Ej Number of living units: -0 Number of bedrooms Number of baths Lot size.__._._.:�+��Qt�r ❑ Wafer Supply: Publics stem Y ❑ Community stem r Y s Y C] Private' Character of soil to a depth of 3 feet: Sand 0 Gravel ❑ Sand Loam a Y 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: t o. of e.from nearest well y.. Distance from foundation.-.--/ ___._...Material.._ ----------------------- -_-_-- •__ _ _ No. of compartments.__.__._•__2_ C--B�'L'F Capacity Size_.s;s� _ Cesspool: Distance from nearest well................. 'h� Liquid depth Distance from foundation_..____..._ ____.. Lining material................. ❑ Size: Diameter_____________________ _ Depth ------------------- •. Prlyy: Distance from nearest well________________________ ' Distance to nearest lot line ................................................ Distance from nearest building .......................................... �l Seepage Pit: _ Distance to nearest well..___ .._ -.__._--Distance from foundation........ ---------- .Distance to nearest lot line___ Number of pits---------------------- Lining material ...... .............. Dis os —Field: =. Size: Diameter .__..._•_-___•___....... pepth___.............. ____________ = Aistance:#ro unda#ion,..�(�istance.to_nserestJotlir�e ��UK Number of lines._-.-•_ Length of /� p Width of trench._..._...P:�,LC�_. - Type of filter material._`}--__-----_-- _-Depth of filter material ..._..�A.��' .... Remodeling and/or repairing (describe)___________________••- I _ ----------------------------------•-----------------•----------------------------------------------.-----•. -•--- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Coun ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)--- ---'=--- ................-•---•---------•----------- ---------------•--.....--••----- By:----- --------------------- { c., must be filed -buildings, ewi(Owns d/ C ontractor - - - �- -----_---(Title}-------------- r art or (Plot plans, showing size of )ot, location of system in relation to wells, buildif. • wit -this application}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY____________________________ DATE-----•. REVIEWED BY_--------•---------------------------• ------------------------------------------------- ----------------- -------•-----..................................................... DATE ......... --------•-------- - BUILDING PERMIT ISSUED ------------- --• . ------------------•------------------ •---•--•------- DATE ---------------•-------- terations and/or recommendations:............... ----------------------- -------------- - -----------------------••-----------------•-....--•---. ----------- --••--------------- ........................................................ ........................................................... ... ........................ ..... - -------•-_-. ISSUED ..... -- -----7�,.5_=.l --------- (Date) FINAL INSPECTION BY:-.--,. 1I ,U'{ iL Date. ---------------- --- - SAN JOAQUIN LOCAL HEALTH DISTRICT (J ' 130 South American Street ES---9--2M 9.50 W=1639 -.-.-Stockton, California ;'