2196 - Laserfiche WebLink

Home Browse Search

A' �� APPLICATION FOR SANITATION PERMIT a� (Complete in Duplicate) w 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. 4 JOB ADDRESS AND LOCATION--------5956---Glen---&t-r---------------------------------------- - - ---------------------------------------------------------------------- Owner's Name--------- 3~$_,_a� ._I &Y�E------------------------------------------------------------------------------------------------------- Phone------------------------------------ Address---------------2-eX31__We-gl-e-ey--------------BerkAley,----Caltf----------- 4--------------------------------------------------------------------------------------- Contractor's Name-------------B.,)-_1it911d-gTEA-----------=------------ ---------------------------- -- - ------------------------------- Phone--?r-' 949---------------- Installation will serve: Residence a Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: M Number of bedrooms2] Number of baths t–LI Lot size__-,5'X_125-1-----------_-_---_--__--___-_--- Water Supply: Public system ® Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [] Clay Loam ❑ Clay ❑ Adobe K] 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 from foundation--------------------Material_---_____-___--------------_-__-----_----------. ❑ No. of compartments--------------------------Capacity-----------------------Size--------------------------------Liquid depth------------- --- -------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------ ------------. ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------- Privy: Distance from nearest well------------------------------------------------Distance from nearest building----------------------------------------- 0 Distance to nearest lot line----- ----------------------------------------- Seepage .Pit: Distance to nearest we!!____ _ __ Distance from foundation------------------- to nearest lot line----------------- n Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Depth----------------_---------------- Disposal Field: Distance from nearest well �Distance from foundation--___6,15-r-_------Distance to nearest lot line--,5r----_---- Number of lines-----I---------------------------Length of each line------65t----------------Width of trench_--24'x------------------------ Type of filter material---1*s_-xt0_0k--Depth of filter material-----16_"_.......... Remodeling and/or repairing (describe):-------------------------------Add-1— g----- 0---pre aenti---$y$te-m---------------------- --------------------------- --------------------------------------------------------------------------------------------------------------•--------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certif that I have pr a d this application and-that the work will be done in accordance with.San Joaquin County ordinances, a iaw , anY4_d' egulat' ns of the San Joaquin Local Health District. (Signed)-- ------ --- ------ ---- -------------- i ---------------------------------------------------- ------ --- wner and/ r Contractor) By:---------------------------- ------- ----------------------------------------------------------------------(Title)- - -�------------------- ---------------- (Plot plans, showing size of lot, location of sys in relation to wells, buildings, etc., must be fil d with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--e_-------- _ DATE-- ------------------------------------------------ REVIEWED BY-------------------------------- --------------------------------------------------------- -------------- DATE ------------------------------------------ BUILDING - ------------------------------ BUILDING PERMIT ISSUED--------------------------------------------- ------------------------------------ ------ DATE �----------------------------------------- Alterations and/or recommendations--------------------------------------------------------------------------------------------- --------------------el f ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ --------------------------------------------------------------------------------------------------------------------------------------------------------------------------�---------------------------------------------------- 0,9n PERMIT No...... 1- �o---- ISSUED---1 --------- (Date) FINAL INSPECTION BY----- -------- ------------- ------------------ ------ Date - -�''----�--------------- = SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California E$-9-2M 9-50,W=1539 � � i