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 <br /> application is made in compliance with County Ordjinan No. 549. <br /> JOB ADDRESS AND <br /> --- ----------------------------y-- ----- --------- <br /> �OCATION------- <br /> Owner's Name_..._.i_11-------- ------- - ---- -- I - - - -- --------------- - Phone------------------------------------ <br /> ----- -- - ---- ----Address-------- f- <br /> -------- Phone--- <br /> Contractor's Name--.-- - -- -- ---- --- ---- -- -­ ------- ------M <br /> Installation will serve: Residence [X Apartment House E] Commercial E] Trailer Court 0 Motel 1771 Other E] <br /> Number of livin �d - Lot size_--- --------- - ------- ---------------- <br /> g units: Number of bedrooms Number of baths <br /> Private 2�� <br /> Water Supply: Public system F] Community system 0 Priv 'ardpan <br /> Character of soil to a depth of 3 feet: Sand E] Gravel [j Sandy Loam [] Clay Loam 0 Clay E] Adobe*OOOH <br /> ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: 0 feet.) <br /> (No septic tank or cesspool permitted if public sewer is available within 20 afer <br /> Septic Tank: Distance from nearest well__Zr#----Distance from foundation--------------------M ---------- <br /> le-A -7--Liqui ep ---- ------------------ <br /> No. of compartments-----------(A----------Capacity_.._,E__47a-----Size-_31-'7"'A _i� �_� j <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material__---------___-_-----_-_________----_. <br /> ❑ <br /> aterial------------------------------------- <br /> ElSize: Diameter--------------------------------------Depth---------------------------------------------------- <br /> Privy: Distance from nearest well____________________________________________ -Distance from nearest building------------------------------------------ <br /> El Distance to nearest lot line------------------------------------------------ <br /> Seepage Pit: Distance to nearest well____.f__0---------Distance f founclat' n-_-lr-------Distance to nearest lot line__)~-_____ <br /> e: Diameter-----,?------------Depth-------1-6-5----------------- <br /> Number of pits----40-7t-k----Lining material.WT-011'elm�_ICW_Tel <br /> 4 <br /> Disposal Field: Distance from nearest well---X-21-____Distance from foundationj----0------------Disfance to nearest lot I linele:�----------- <br /> Number of Length of each line--- -----Width of trench-------;_Z---------------------- <br /> Type of filter mate of filter material-- ------------ <br /> Remodelingand/or repairing (describe)---------------------------------------------------------------------- ------------------------------------------------------------------ ------------- <br /> -------------------------------------------------------------------------------------------------------------------------I----------------------------------------------------------------------------------------- <br /> ------------------__--------------------------------------------------------------------------------------------------------------------------------------------------------11------------------------------------------ <br /> ------------------------------------------------------------------------------------------------------------------------------------I---------------------------------------------------------------------------------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)--- - . f ---------AZ�Z_�------------------------------------------------------------------------------------------------(Owner and/or Contractor) <br /> By:-----------------------------------------------------------------------------------------------------------------------------------(Title)---------------------------------------------------------------- <br /> (Plot plans, showing size of let, location of system in relation to wells, buildings, etc., must be filed with this application). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--- e7 ------------------------------------------- DATE--- -------/ft ---------------- <br /> -------- -X-A <br /> - ----------------------------- DATE BY---------------------------- DATE--- <br /> 4.r �;� <br /> 1; of <br /> BUILDINGPERMIT ISSUED------------ ----------------------------------------------------------------- DATE-—--------------------------------------------------------- <br /> Alterations <br /> ATE------------------------------------------------------------- <br /> Alterationsand/or recommendations:-------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------------------- -------------------------------------------------------­-------------------------------------------------------------------------------------------- ----------------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------­----------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------ --------------------- <br /> P,-------------------------------------------------------- -0----- ----- ---------------------------­-----------*---------------------------------------- ---------------- <br /> .14-0--------------------------------------------- <br /> Date------ <br /> ------------------------------------- <br /> PERMIT No. ....... ISSUED---- <br /> -/_ --------- (Date) FINAL INSPECTION BY, <br /> Date------- -------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-2M 9-50 W-1639 <br />