1003 - Laserfiche WebLink

Home Browse Search

A�PLICATION FOR. SANITATION PERMITo (Complete in Duplicate) A Local He, a perm TAplication is hereby rnclefo tZoSa Joa�q,',, Health District for if fVconstruct and install the work herein described, , application is made in compliance with County Ordinance o. 549. 0 JOB ADDRESS AND LOCAT ON -/__-e------!/--------------------- --------------------------------------------------------I------------------------------------------ Owner's Name ------- ---- ---- Address-------u.?t! - -- ------------------------------------------------------------------------------------------------------------------------------------------ Contractor's Name---------- ------------------------------------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence [Apartment Hous6 E] Commercial F] Trailer Court E] Motel E] Other Ej Number of living units: V Number of bedrooms 9 Number of baths d Lot size____1'0__ ------------------------------ Wafer Supply: Public-system [�ornmunify system 0 Private E] ------- Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam El Clay Loam E] Clay E] Adobe Zrilardpan E] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) CN).-I e'11- 1_> - - -Distance from foundation -%,- Septic Txk: Distance from nearest w 4 A 1� ---__ Material----- ------------ No. of compartmen ---Liquid depth---SX------------------ fs-------;7---------------Capacitypo---0--------Size- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_____ __------------ -------------- ElSize: Diameter---------------------------------------Depth---------------------------------------------------- Privy: Distance from nearest well--------------------------------------------------Distance from nearest building_______________-_--_-----___----_--______- } uilding------------------------------------------ El Distance to nearest [of line_______________________________________________ F Seepage ine----------------------- ------------------------ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_________________ El Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Depth--------------------------- Disposal Field: Distance from nearest well_7?k?�A___.Distance from foundation_-/-O-!.'7-j!-'--'---Disfance to nearest lot line-'S..-110 ------�4 :. Number of lines-----_ ------------- ---------Length of each line____f_ of trench----�7_)C.......... ----- Type of filter material___ ateriaI__: X----------Depth of filter material___ -------- Remodelingand/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)-.-........_14-15 ----------------------------------4-�!----------------------------------------------------------------------------------------------(Owner and/or Contractor) By:---------------t--------------------------------------------------------------------------------------------------------------------(Title)--------------------------------------------------------------- (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 'Y-------------i ---------------------------------------------------- DATE-----------------------------------------,t-------------- REVIEWED BY----------------i------------------- ---- DATE —� ,/ g ---- BUILDING PERMIT ISSUED---------- --------- --- - -------------------------- DATE- /------------- --- Alterations ------------------------------- and/or recommend aitrons:--------------------------------------------------------------------------------------------------------- --------------------------------------- ------------ --- ---- ------------------------------ I ------------- - ----------------- -------------- ------- ---------- ----—---------------- ---------�-gA ------------ ---------------------------------------------------------- ------------------ ------------------ --------------------------------------------- ------------------------------------------------------------------------------------- --------------------- PERMIT t 4 No.-,/--"- - --,d--- ISSUED---------- (Date) FINAL INSPECTION BY:------- --------- _,x---------------------- Date---------------2 AZI---/Z/ �-�----- ------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W-1639