594 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT -� (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. JOB ADDRESS AND LOCATION--------------- --ztj'---5Cho-Q1 ---------------- -- Owner's Name-------------John_D_.---9}2ttake-r-t-------------------------------------------- -------------------------------------------- Phone------44122------------- Address---•- ------101` ---N•__S_ChaC1 Contractor's Name--------------Deit.-a------------------------------------------------------------------- --------------------------------------------- Phone---j-_39.55--------------- Installation will serve: Residence ©: Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livingunits: Number of bedrooms ❑. [3 Number of baths Lot size---------45-Xl,3Q------------------------------------ Water Supply: Public system :E iCommunity 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 ________________-__.________________-._________. £:MMING No. of compartments-------------------------Capacity-----------------------Size--------------------------------Liquid depth-----.------------ Cesspool: Distance from nearest well-----------------Distance from foundation-------------------_Lining material______---_____________________------ j ❑ Size: Diameter--I------------------------------------Dept h------------------------------------- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-------------------------------------- 171 Distance to nearest lot line_____________________-_____--_-----------____- Seepage Pit: Distance to nearest well_______ ----------Distance from foundation ./,.!7_______-Distince to nearest lot line____--------- �: Number of pits___:___IX---Z--Twining material-br-i.C_�---____Size: Diameter------ `� --------.Depth----------- o_ ------------ Disposal Field: Distance from nearest-weft-----__________.Distance from foundation-_______________.Distance to nearest lot line----------------- EAIVING r Number of lines-_J--------------------------------Length of each line............-...... -...........Width of trench Type of filter material _________________-----__Depth of filter material------------___________ Remodeling and/or repairing (describe):--------1xM_ta13J _nejj-__V�' pkIia=g ink__ r h__; fll .d. line k-elfve---------Dl c�!rc -----0- v, ----------------------------------------------------- �. ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify that I have prepared this'applicafion and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and' regulafions of the-'San Joaquin Local Health Distric+. (Signed) Dei-a- LL, - - --- -- -- (Owner and/or Contractor) BY� P ]C' 'jt �'-th11_ pf ---------------{Title)_OuFtl '-- �s' .--------------------------- (Plot plans, showing size of lot, Iota+ion of system in'relaMon to wells, buildings, efc., must be Pled with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------- - DATE �} --------------- -- 4 REVIEWEDBY--------------- ---- ---------------�--------- -- ---------------------------- - ------------------ ---=-- DATE---- - ----------------- --------------- ------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE Alterations and/or recommendations:-- - - -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -- �s -------------------------- ----------------------------------------- ------------------------- ------------------------------------------- -------- .PERMIT No• - - ISSUED------ _ 1________(Date) FINAL INSPECTION BY:------- -_t)___ ------,-------------------- Date _ ----------------- Date------------------------ 5 SAN JOAQUIN LOCAL HEALTH DISTRICT I 130 South American Street Stockton, California ES--9-2M 9-50 W-1639