Laserfiche WebLink
67 <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) <br /> i <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 /> JOB ADDRESS AND LOCATIihON-------------f ----------_-- _ -- _ <br /> Owner's Name---------------- -15�--------- 1'�''L101ia J 1 --------------------- <br /> -----------�---- Phone------------------------------------ <br /> Address--------------------------------- --� --cl-s __ -------------- --- ---------------------------------------------------------------- <br /> Contractor's Name------ ;i- __ \=: t�-.++ .�; Phone--- ------------------------ <, <br /> Installation will serve: Residenl,.e P___xp­1rtment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units:)d] Number of bedrooms ❑ Number of baths ❑ Lot size_____---, -- __�__. -_---._--------------- <br /> Wafer <br /> -- --___ <br /> Wafer Supply: Public system❑ Community system ❑ Privater y <br /> wJ <br /> Character of soil to a depth of-3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan.h <br /> TYPE OF INSTALLATION AND.SPECIFICATIONS: <br /> (No septic fank orcess'ool permitted if public sewer is available within 200 feet.) <br /> 0 .." i <br /> eptic+T nk: Distance from nearest well_________________Distance from foundation__:__-____________-Material.___________-_______________________.__- -____. <br /> � <br /> No. of compartments--------------------------Ca acit ------------------Size--------------------------------Liquid depth-------------------------- <br /> -Cesspool: <br /> -----------------_----_-_. - <br /> •Cess ool: Distance from nearest well_________________Distance from - <br /> p � mfoundation____________________Lining material_____________:___---____-_-___-__ _ _. �. <br /> ❑ DeptSize: Diameter-------------------------------------- 1 <br /> h---------------------------------------------------- I <br /> I . <br /> -Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------------------------------- <br /> El Distance to� nearest lot line-----------_______-________-___________-______ <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lof line--__._.-_____-__ <br /> ❑ Number of�pits----------------------Lining material-----------------------Size: Diameter------------------------Dep <br /> Disposal Field: Distance from nearest well___ _ =_-.Distance from foundat' n__ ----------Distance;to"nearest lot line- <br /> Number of-�lines----- <br /> - <br /> _ __ _______ Length of each line__ ) _�___.1Nidt'n of trench_______ _ _______________ ' <br /> Type of filter mat rial-- - ,._ _Depth of filter material_____fo �.__ e <br /> Remodeling and/or repairing (describe)------------------ -- ----------------`--------------- --------------•-____-- <br /> 'I' ------- - -- -_----A---------------------------------- ------------- <br /> -----------------•-------------------------------------------------------------------- <br /> -------- --- <br /> I� <br /> --------- --- ---------------- -----------------�---—---P-----------------PP--------------------------------------------------------------:------------------------------.------------------ ---- <br /> herebycertifythat I have prepared this application and that the work will be done in accordance with San Joaquin <br /> uin County <br /> ordinances, State laws, and rules and regula#i neo'"he San Joaquin Local Health District. <br /> (Signed)-___' - '` ®�.> - (Owner and/or Contractor) <br /> ----A----- <br /> By 11 (Title)_ <br /> (Plot plans, showing size of lot,I.ocafion of system in relation+o wells, buildings, efc., must be filed with this application). <br /> I� <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-------------------- - ---------------- ---------------------------------------- DATE-------------- ------:--- j <br /> REVIEWEDBY------------------------- 1M-------------------------------------- ----------------------------------------------------------- DATE----------------------------------------------- ------ <br /> BUILDING PERMIT ISSUED----,I <br /> -----------------------------------------------------�---- ---------- ---------- ---- DAT ---- ----- <br /> r_ _Alterations and/or recommendations: _.�-______r� ____ <br /> ---------------------------------------------------------------------------------------- <br /> _ <br /> ------------=----------------------------------------------------------------------------------------------------------------------- <br /> IM <br /> -------------------------------------- -------------------------------------------------`----------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> ----------------------------------------------------------------- <br /> IM <br /> IM <br /> ----- <br /> PERMITNo <br /> Ny',:�__'?------ 15SUED------_ Date FINAL INSPECTION B ! ------------------------- ------ r <br /> Date_ /------------------- <br /> r SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> �9-2fv! 9-50 W=1634 - <br />