664 - Laserfiche WebLink

Home Browse Search

' APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) 4 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in'�compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION_�96 E/ks---- 7/.lfS 1�-- Q__ Owner's Name--------------------------------------7�4CZL---- ----- _ ------ Phone------------ --- p ---------------- ------------------- -- ------ ----------- { Q a� aElil�E ------------------ Addressa�y�/ =' Contractor's Name-----------I1-------•--r f F ' 'c Q�zS-: X77e------------------------------------ Phone = Q7 Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ _Other ❑ 11M Number of living units: 'V1 Number of bedrooms B& Number of baths ID Lot size___ __ __f_ �— Water Supply: Public system ❑ Community system ❑ Private EK y ------------------------------------ �I } Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Ej Adobe jK Hardpan ❑ 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 fro foundation__`_.Maferial ia!« ,e. -�OQ..-k------------- 0 a .� No, of l`ompartments______________�_____Capacity_,. -0--4----_Size_v�__06 ___Liquid depth___.A_2_______-,-__ Cesspool: DistanS from nearest well_________________Distance from foundation-____.____I_.______Lin'sng material------------------------------------- r [ �q ❑ S iz�D i a m eter--------------------------------------Depth---------------------------------------------------- �\1 Privy: Distance from nearest well-------------------------------------------------Distance from nearest building________._________.____________________. I ❑ Distance to nearest lot line__---------------------------------------------- Seepage ____________________________________________ Ir Seepage Pit: Distance to nearest well______________________Distance from foundation------------------..Distance to'nearesf lot line----------------- F Number of pits----------------------Lining material-----------------------Size: Diameter.-----------------------Depth--------------------------------- p e from nearest well-'- Distance from foundation__��________Disfance to nearest lot line__��______ .Dis�osal Field: Number' of lines..________' v ----' ---------------Length of each line Q'a ----- Width of.trench------=Zil r Type of�filter material-- ---x,-___ _ Depth of filter material___.___II_ a '-Remodeling and/or repairing (describe:.--- = f 7 -(1- / ----`- --ri h�-------J1.S-......� ,PFA m�-n -----------------'p----- 3� ' i'1�,---------------------------------- 1 ---------------r-;-------------------------------------------------------------------------------------------------------------------------------------- IM , ,. 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, andl rules and' regulations of the San Joaquin Local Health District. (Signed)----�'�6- +1 � L - .1_ - __ -_�11.Ot7S_ { -----=----------- --------------------------------------------------- --(Owner- 'IM and/or Contractor -- ----- ----- "�,..t Y• - ; - - -- -- - - - - - - - - (Title)---��l��Q_t;?.._------------------------- -k' -----: - � -- ------ (Plot plans, showing si a of lot, location of sy m in relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .----- ` �---------------------- ---------------------------------------- DATE------------ REVIEWEDBY------------------------------------------------------------------------------------------------------------ ----------------- DATE_--------------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE- ------------------- Alterations and/or recommendations-------------------------------------------------------------------- ------------ I -------------------•----------------------- ------------------------------'------------------------------------------ ----------------------------------------------------------------•--------------------------------- -------------------------------•---------------�-----------•-•-----•----------------- ------------ ------------------------------------------------------------------------------------------------------------------------- I - . -----------------=------------------------------------------------------------------------------------------------------------------------------------------------------------------------•---------•---------•------------- ----------------------------------------------- IM ---------- PERMIT No---- - ISSUED______ _-- -- _ -- /- ---J__ - --____--(Date) FINAL INSPECTION 8Y: --------------------- Date----------------- " SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California i. ES-9-2M 9-50 W-1639 w #`