827 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT 1 (Complete in Duplicate) Q Application is hereby made to the San Joaquin Local Heaith District for a permit to construct and install the work her in ascribed rx This application is made in compliant ounty Ordinance o. 549. �f , JOB ADDRESS AND LOCATION._ ______� :�_s_'.-( �' Owner's Name - Address_--------- ; y Phone----- --J---�- ��- = 037=3W--- Contractor's Name___________ ____ Phone---,5e_Installation will serve: Resi ence�Apartment House E] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of beclroomsg Number of baths " — S'" � Lot size__^-= �-----X__-_-- � ___'_ ____________ ' Water Supply: Public system ❑ Community system ❑ Private / �� Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ ClayLoam Ga ❑ y ❑ Adobe D3,0 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 f m f dation___-`_ ,Mat Tial----� No. of compartments __-- ------------ p Capacity Size_��r__'CA-11 _ ` I Cesspool: Distance from nearest well_______ ________ ' " S� Pe .�_ "' Liquid depth__. -. -- - Distance from oundation____________________Lining material-------------------------------Size: Diameter----- -------- ---------•------------Depth------------------ ----------- rivy: Distance from nearest well________________________________________ _ Distance from nearest building Distance to nearest lot line - _ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line-----------._____ ❑ Number of pits-------------- - Lining material-----------------------Size: Diameter------------------------Depth------ ------------------------- Disposal Field: Distance from neares ell-� �-: _.Distance from foundation; -�+_-------- Distance to nearest lot line___' --`-_- Number of lines-__'___.__�--------------Length of each line �'� g tidth of trench -------- Type of fiiter material-------------------------Depth of filter material Remodeling and/or repairing (describe):__________________ -------------- , ,_ --------------- ------------------------------------------ = 4- ---- - ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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 a rules and reg ula ions of the San Joaquin Local Health District. (Signed) 1�? i"; = ------------------------ By: (©wrte�and�}ar J� -------------- ="` ' +� t -- ontrac ��• - Contractor) � i --------------------------- --- ------- Titley (Plot plans, showing size of lot, location of ystem in relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------- DATE. ---- REVIEWED BY ------------- ------------------- - ------- -- - DATE------ --------- . - :-�-j--- ----------------- BUILDING PERMIT ISSUED------------------------------ -------- ------------ ------ -------- ------------- DATE---------------------------- ------------------- A Alterations and/or recommendations_________ -------- ------------- ------------------------------------------ --------------------------•--------- ----------------------- ----- ------------------------------- ---------------------------------------------------------------- 7 ---------•---------------------------------------------------•------------------------------------------------------------------ - --- PERMIT No.`!l__-__ __ ___ ISSUED------- _(Date) FINAL INSPECTION BY:----------1001, -- 4 --------------- Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ES-9-2M 9-50 W4639 Stockton, California