Laserfiche WebLink
J, <br /> 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 application is made in compliance with County Ordinance 549. <br /> JOB ADDRESS AN LOCATION------ ------- ---------------------------------------------------------------------------------- <br /> 7--- :e <br /> Owner's Name---- X. .......... - ------ --------- ---------------------------------------------------------------- <br /> ---------------------------------- <br /> ---------------------------------------------------- ------------------------------------------------- <br /> Address------- ---- ---- -- -- ------- <br /> Phone-_'? <br /> Contractor's Name_- <br /> Installation will serve: esidence Apartment House El Commercial El Trailer Court F <br /> Motel Other El <br /> ----------- <br /> Number of living units: Number of bedrooms„[ Number of baths d Lot size--- !F2 - <br /> f --------- ---- ---------- <br /> Water Supply: Public system Community system El Private 1:1 <br /> Character of soil to a depth of 3 feet: Sand 0 Gravel E] Sandy Loam El Clay Loam El Clay E] Adobe F] Hardpan <br /> ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> eriaI___,,V <br /> Septic Tank: Distance from nearest wail_________ X-------------- <br /> J',Q_eJ------Si,e,fYAV__V)-1-------Liquid depth---;/ ----------- <br /> —------Distance from foundation------- -- ------Mat <br /> No. of compartments----------- --------------Capacity--- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation____-__ -__-______.Lining material__,_________--___________________ ;�,, <br /> ❑ <br /> aterial------------------------------------- <br /> F1Size: Diameter------------ -----------------------Depth---------------------------------------------------- <br /> Privy: Distance from nearest well______________________________-__.______- --Distance from nearest b0cling--------------- ------------------------- <br /> Distance to nearest lot line____________ ___________-_-________________ <br /> Seepage Pit: Distance to nearest well______—____ __----:_Distance from foundation--------------­----Distance to nearest lot line-----!; ------- <br /> ;­�' - -- <br /> Number of pits-------- -----------Lining material ------Size:�S. <br /> ze; Diameter------I--------------Depth- --------- --- <br /> � <br /> —-- -------- <br /> �e - <br /> D sp sai Field- Distance from nearest well_-—---------Distance from foundation--- 77��---------Distance to nearest lot i <br /> Number of lines_______I__ ------ -- -----Length of each line----le - ----,--.-.Widtk of trench---,P--------------- -------- <br /> Type of filter material-" t2_____-Depth of filter material--- - -------- <br /> Remodeling and/or repairing ----- ------ <br /> E. <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------­­­-------------------------Wa ------- ---------------------------------------------------------------------------------------------------*---------------- <br /> r A------ <br /> I hereby certify that I have ca on an that the work will be done in accordance with San Joaquin County <br /> ordinances, Staf"y—vs)and rule; a 4. egul. i e.of'f e San Joaqu I HealtfDi.sfric+. <br /> .h -----------------------------(Owner and/or Contractor) <br /> -------------- ------ <br /> (Title)---- ------- <br /> By:--------------------------------- ------------------------------------------------------------------------ <br /> (Plot plans, showing size of o location of system in relation to wells, buildings, e4c., must be Ned with this application):/� <br /> FOR DEPARTMENT USE ONLY <br /> ------------------- ---- ---------------------- <br /> APPLICATION ACCEPTED BY------------------�LAP----'- -------------- -- ------- ------------- <br /> DAI <br /> REVIEWEDBY------------------------------------------------------ --------------------: ---------------------------- ----------------- DATE-------------------------------------_--------------------- <br /> BUILDINGPERMIT ISSUED-------------------------- I-------------------------------------- ---------------------------------- DATE----------------- --------------------- --------------------- <br /> ----------------------- ----------------------;------------------------------- ---------------------------------- ------ ---------___----------------- <br /> Alterations and/or recommendations. <br /> ------------------- ------------ ---------------------------------------- ------------------------------------------------------------------ -------------------------------------------------------- <br /> -------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------- <br /> ------------------1- <br /> ---------------------------------------------------------------------------------------------- -------------------------------------------------------------------- <br /> -------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------;--—--------------------------- ------------------------------------- <br /> 4K <br /> PERMIT No.1-IN----------- ISSUED----- ---------(Date) FINAL INSPECTION BY:---------W__�---R-------------------------------------- <br /> Date-----------------------It <br /> --------------------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> I ES-9-2M 9-50 W-1639, <br />