Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT U, <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. A• t <br /> This application is made in compliance with County Ordinance No. 549. _ <br /> JOB ADDRESS AND LOCATION....................... -•K--------- .........................................................� <br /> f <br /> L --- Phone--••..........................Owner's Name.._.... MQe -M /_._ <br /> Address........................................ <br /> �- <br /> Contractor's Name............................... a'=_00 1 <br /> .............� - ------------ <br /> .-..----------•------•----•------•---- •---•-•-••------- Phone-----------•--•--•---------------- <br /> Installation will serve: Residence 4 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: '❑ Number of bedrooms Number of baths [ Lot size...._•_ - .................................. <br /> L----------------- <br /> Water Supply: Public system ❑ Community system ❑ Privatex <br /> 1 Character of soil to a'depth of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam❑ Clay ❑ Adobex Hardpan ❑ ` <br /> TYPE OF INSTALLATION AND SPECIFICATIONS." <br /> (No septic tank or cesspool permitted if publics�sse��weJrr is,�v- ilable�within 200 f .) j r) <br /> Septic Tank: Dist nc fri^near st well.(_'.Q":.-""Efis"iance from foundation._--._-_-_ <br /> -,r� Material <br /> 1 ompartm6 s........-................Capacity.......................Size.....-----..._--- -------•----Liquid depth----•-•-------------•-- <br /> Cesspool: Distance from nearest well... ............Distance from foundation....................Lining material........-_........_.........---__.-_ W <br /> ❑ Size: Diameter__ ......................... <br /> _ <br /> Ili <br /> Privy: Distance from nearest well•........................................ Distance from nearest building.---._.._•._______-._.------_----------- <br /> 171 <br /> --_-- __-_---._.-.❑ Distance to nearest lot line________________________________________________ <br /> Seepage Pit: Distance to nearest well•---------------------Distance from foundation....................Distance to nearest lot line--------......... <br /> ❑ Number of pits---------..--------_Lining material--.....................Size: Diameter------------------------Depth-------_................ <br /> .------ <br /> i os Field: Distance from nearest well_Sc --------Distance from foundation.__--/d--------Distance to nearest lot line......`S�-_ dv <br /> Number of lines_______________L-----------------Length of each line....___--_&P..�4,5-widfh of french-------2-- <br /> Type of filter material......................_Depth of filter material....................... l—l-V & 6d <br /> Remodeling and/or repairing (describe):..........45L--.Veia �►-------IM--------- 1 �;•�r••r------------ <br /> --------------..................................................-----------•----------------••------•-----•---•-------------•----------•---•------•-------- ---------&---------•--------------.------------------------­------------ <br /> .....-.....................------........................---­------------......--•---........•---•.-•-•--•-•--------•-•----•--•---------••---•-----------•••--•--••••-•----...•--•-•--•---•----...-••-•------- <br /> ---•--••••--.....------•--------•--•••----•-•----•- -- -•-•--•••-••••---••------•------•--••• ...... --- -•---.....•••--........_.••-•-••...................................•••-•••-------•---------......--•--•-------- <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) >� ---- - ----- ------ --------- -----------------------------------------------------------------------.(Owner and/or Contractor) <br /> by:----------------------------------------------------------------- ---------- -----------•---------------------------------- itle <br /> (Plot plans, showing sae of lot, location of system in relation to wells, buildings, etc., must be filed with this application). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY • . . •-- -•••--. ._......... . <br /> -••---•....._ . ........ DATE........ <br /> REVIEWEDBY---- -------------------------- ------------------------------------------�'~" ..................................................... <br /> ....---•--•---•-•-•--- •----------•-•--••-- DATE <br /> --•----- <br /> BUILDING PERMIT ISSUED - --------------------------------------------------------•-•-•- DATE-----------------•----------------------- <br /> Alterations and/or recommendations:..-•----••-•--......---•----•--------------------••••-- <br /> --•--- <br /> or� ; <br /> -------•--•-------------------------------=-=--=-- ----- <br /> 77 _ <br /> 46 <br /> _ _ <br /> PERMIT ISSUE _----- -= ------ ----(Date) FINAL INSPECTION BY:............................................................... <br /> Date......................... <br /> Y:..................................................••----------•- <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 />