Laserfiche WebLink
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. i/ <br /> S-/ y1--C,-/-a--1--�' ------------------------------------- <br /> �JOB ADDRESS AND LOCATION-------------�-`�/-- !!-__---Sd --- ----------------------------- <br /> -- UCC i! ----------- Phone------------------------------------ <br /> Owner's Name---------- �------------- ------------ ------------- ------- <br /> Address rl r� �� `5-------�-1 J -y`------ ----- - ---- ------------------------------------------- { <br /> ----------------------------------------- Phone----------------------------------- <br /> Contractor's Name-------Z--��-�--�--A'-Y-'--- - ---------------- ------------- ----------- - <br /> Installation will serve: Residence [,/Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [I Other ❑ 1 <br /> Number of living units: pj Number of bedrooms [�_ Number of baths © Lot size-------------------------------------------------------------- i <br /> Wafer Supply: Public system Community system ❑ Private ❑ <br /> Character of soil to a depth of 3 feet: Sand F] Gravel E] Sandy Loam E] Clay Loam E] Clay ❑ Adobe E] Hardpan I—] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material_________--_--------_------------_---_--_-------- <br /> ❑ No. of compartments--------------------------Capacity-----------------------Size--------------------------------Liquid depth-------------------------- <br /> Cesspool: Distance from nearest well-_------____---Distance from foundation---- ---------- Lining material_-__---_._-_----__-__-.-----_--_----. <br /> ❑ Size: Diameter--------------- ------Depth-._-------------------------------- -------------- <br /> �rPrivy: Distance from nearest well-------------------------------------------------------------------------Distance from nearest building------------------------------------------ <br /> ❑ Distance to nearest lot line------------------------------------------------ <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- <br /> 0 Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Depth--------------------------------- <br /> Disposal Field: Distance from nearest well-----------------.Distance from foundation--------------------Distance to nearest lot line---_.---__-_----- <br /> ❑ Number of lines_--------•-------------------------Length of each line------------------------------Width of trench----------------------------------- <br /> Type of filter material_--------------- -----Depth of filter material---------__----_-__---- <br /> -Remodeling and/or repairing (describe):-------------- - '�^n�------ - ------ - <br /> ------ ---------- <br /> ----------------------------------------------- <br /> -------------------- <br /> - <br /> -------------- � _`------- ----- '------------------------------------------ <br /> -------------------- ----•- <br /> -- ---------- <br /> _____ <br /> - ---- - --- ------------------------- <br /> I <br /> - - - ------------- <br /> hereby certify that l have prepared this application and that the work will be done in accordance with an Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health Disfrict. <br /> ------------------------------------------------------------------------------------------------(Owner and/or Contractor) i <br /> BY: ---------------(Title)---------------------------------------------------------------- <br /> (Plot plans, showing size of lot, location of system in relation+o wells, buildings, etc., must be filed with this application). <br /> FOR DEPARTMENT USE ONLY <br /> ----- DATE-------1 2 ' .S"/----------------------- <br /> APPLICATIONACCEPTED BY--------------------- ----------------------- --- --------------------------------- Z• SY 1 <br /> BY--------•---•---------------•- =---------------------------------------------- <br /> --- ---------------- --------------- DATE----- --�'------------------------------------------------ <br /> REVIEWED t <br /> ------------------------- ------ --- f <br /> BUILDING PERMIT ISSUED------------------------------------ - ------- DATE <br /> and/or recommendations- ----------- ----- --------------- ---------------------------------------�1-�(if <br /> ------ `r <br /> ------------------------------------------ ------ <br /> -------------------------- <br /> -------------------- <br /> --------------------- ---- --- --- -- "f--- ----------------------------- <br /> PERMIT No._ _11 --------- ISSUED------1--- <br /> -------------- 1--_--_-_---(Date) FINAL INSPECTION :__ <br /> --- __ _-•---------------------------------- <br /> w, <br /> kDate----------------/ --- -- -- --- -- -- - -------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES--9-2M 9-50 W-1639 <br />