51 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Y 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. A JOBADDRESS AND L ATION------- zi----7- ------------E-- 5-------------------7---------------`---------------------- -------------------------------------------- //�� Owner's Name---`-.- n----- "�/ � -t �-------------------- ------------------------------------------------------------- Phone---- ------ Address--------------------------------- - '-----------------------'--------------------------------------------------------------------------------------------------------------------•-------. n i Contractor's Namd---------2--'--D---a---•- ,'- - -- ---------------------------------------------------------- Phone---��-------o-- --------- Installation will serve: Residence', Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: [1] Number of bedrooms (V Number of baths U] Lot size___ 1 Water Supply: Public system Vcommunify system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand Gravel Sand Loam- Clay Loam Cla Adobe [Hard an NJ p ❑ ❑ Y ❑ Y ❑ Y p TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) p 0 Material--- (3_!R--`C'I_'�----------------------- No. ---- (' Septic Tank: Distance from nearest well_�_7-�__Distance from-foundation__""__ ---------------- No. of compartments----------2------------Capacity--9-4-9--------Size--- x {quid depth---------------------- Cesspool: Distance from nearest well_________________Distance from foundation---___________---.Lining material------------------------------------- El Size: Diameter-- ----------Depth-•------------------- ----------------------------- Privy: Distance from nearest well...________" . -______7____'___________________Distance from nearest building-------------------------------------- ❑ Distance to nearest l Seea a Pit: Distance to nearest wellsinl__ S_Distance 4from y{foundation'--_ Q_____-Distance to nearest ]of li e/"1:5____---_ Number of pits-----�'-----.- :---Lining material-----------------------Size: Diameter.,.----------------------Depth-------- -------_'-____-� � Dis :e os Field; Distance from nearest well-1-7 from foundation----:�__ -------Distance to nearest lot line} �_________ p Number of lines-------------- I-------------------Length of each line------------ _ ---------Width of french------a;�_-------_-___------- Type of filter material__ #___R64o_k,Depth offilter materi'Z�__,2,9______ 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 County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) -`�. •�►�+ (Owner and/ Contractor) o - % r - -------------------------------------- -- --- --- - - Title - ------- ---------------- (Plot --------------(Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be fled with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- - --- --------------------------------- DATE-----=-------- ---9I REVIEWEDBY-----------------------------------------------------------K--------------------------------------------------------------- DATE---------------------h------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------- Alterationsand/or recommendations------------------------------------------------------------------------------------------------------------------------------------------ -------- ----------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- . --------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------J------ PERMIT No---------SA---------- ISSUED------------------------------------------{Date] FINAL INSPECTION BY:--------------- -- ---- ------� _ i ------------------------------- Date--------------------- /---- --- - 1 ------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street I Stockton, California 7 ES-9-2M 9-50 W=t639 .r