2013 - Laserfiche WebLink

Home Browse Search

H APPLICATION FOR SANITATION N PERMIT , 3 �V T (Complete in Duplicate) Ap Thiplication'is hereby made to the San Joafquin Local Health Dist ricf�for a permit t`construct §nd 4 �t II the work herein descri d: s application is made in compliance wifA County Ordinance No. 544, JOB ADDRESS AND LOC ATION-------_-R _11_,-Bsax:-2-_ Q_----- e 104 -------- ,� 'l r Owner's Name IT�aQ :'- �Sly!------------- �/ - - Phone-_---- � �3--I�o -3- 1. v Address_ = Rt A 's----Bo—x---P 9jD_ I'O�,i.� �' _ . .'Q 2� �� Contractor's Name------------------------- -------------------------- -------. • f----- ---------------- Phone----- 915 Installation will serve: Residence ApartmentHOuse ElCommercial ❑ Traiier Court ❑ Motel [❑ Other ❑ 5 Number of living units: El Number ofbedrooms: Number of baths M Lot size_____..._5f�- fl------------------------ x t -- � Wafer Supply: Public system ❑ Community system ❑ Private Character of soil to a depth of 3ffeef: Sand ~❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe® Hardpan [] _TYPE.OF- INSTALLATION AND.SPECIFICATIONS.- z -- - - --= - - — �--� T (No peptic tank or cesspool permitted if public sewer is available within 204 fegt.] Septic Tank: I Distance from nearest well______________ Distance�rom ,foundation...._/ Material INCA No. of compartments-----------------------Capacity----------1------------Size Liquid depth - Cesspool: i Distance from nearest well---=-------------Distance from foundation--------------------Lining material---------- -------------------,_- i ❑ ( Size: Diameter------ l-----I-----`=--------------Depth.-------------------------------------------------- P.r�i y: Distance from nearest well..:..............................................Distance from nearest building-------__.....____,...-___ ------------- Distance to nearest lot line-----------------------------°----------------- ` °'t . Seepage Pit: ' Distance to nearest well-------],Dp----:_Distance from foundation------1Q -------Distance to nearest ❑x °t Number of pits:.__._.,:.------------Lining material---brInk-----Size: Diameter_ _'t•____:--.Depth____._. _r -...J.. . is posa L, I di .i._ istance from nearest-well--------------- -Distance--fromfoundatkion=+_.-_Distance-to nearest-lot-dine __=-7: EXIT �ir Number of lines-- -------------------•--------•---Length of each line------------------------------Width of trench-------------- 77L;. - TXpe of filter material-________________________Depth of filter material----------------------- Remodeling''and/or __---_--_-..-___._-Remodelingand/or repairing (describe):------------.---I_nstall. iaq---T1�L�---�r3r. _ir2:1---d�'L'�-_z?1'__sQnl r---and.thP----------------- a39-r.er---WIL t,_h Qk..?z ---fhe.._-rent-I.c, I zr�.ir__.zr.��h him �aT::� ha�.L��n� ?•� ------------------------------- ----------------- -----------:4----'----------•---- --------------------- - ----------------------------------------- --------------------------------------------------------------------------------------•----------------------------------------------•--------------------•----------------------------------------•--------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Coun ordinances, State laws, and rules and' regulations of the San Joaquin Local Health District. (Signed)-------D.elta----------------------------------------------------------------------------- -- (Owner and/or Contracts - (1Etle)- QIt r--3:,. (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 BY ---------------------------- --F---------------=--------------------- DATE - REVII WED BY ------------------- ----------------------- DATE---------` BUILDING PERMIT ISSUED------------- -------------------- ---- c � f ,� --------------------------------------- DATE---------- -------------------- ------------------ Alterations and/or recommenda+ions__ ____________________ ---------------------------------------------------- ---------------------------•---------------------- ----------------------------------------------•---------------- € ----------------------------------------------------------------------------------••--•-•--- i ____________________________________________-..__ _._.____. ...____.... .___.__.__-_-.________.....______-...._-.........____...._-...____......._.__._.......______.-...__._._ ....-__--..._.__.___..-___-..._.._ --------------------- -------- PERMIT 1- ____-- ISSUED--- `--- -----------(Date) FINAL INSPECTION BY--------- ---- --- -------- - Date--- / t ------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130'South American Street Stockton, California ES=9-2M 9-50 W-1634 #