1068 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT { / (Complete in Duplicate) Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. AppiY This application is made in compliance with County Ordina e N . 549. - ------------------- JOB ADDRESS AND LOCATION________ --- -------'- )-` -- -- ---------- Phone--- ------------ ------ Owner's Name--------- ------ ---------=------- Address----------------------- Phone_ " - 2"------------- �- Contractor's Name---------------- ❑ Other ❑ -- -------------------------------------------- Installation will serve: Residence ❑ -Apartment House ❑ Commercial WTrailer Court El Number of living units: ❑ Number of bedrooms ❑ Number of baths ❑ Lot size------ _ Water Supply: Public system Community system ❑ Private ❑ Clay Adobe Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Y ❑ 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-Liquid depth_____-_____________ Size------------------------------- ❑ No. of compartments--------------------------Capacity----------------------- , Cesspool: Distance from nearest�well__�"------Distance from foundation_______/__Q_�_--.Ding �laterial____h"Q�---- - � Size: Diameter------ - -- _ ---------Depth-------� -- -`�= fir __."_""- Distance from nearest building----------------------------- ----- V (Privy: Distance from nearest we _________________________ See a e Pit: Distance to nearest well_____________________Distance from foundationDistance to nearest lot line---------------- Seepage ______________. ❑ Distance to nearest lot line 9 t � Number of pits--•------------------Loring material-----------------------Size; Diameter------------------------Depth----------------------------- --- r❑ Disposal Field: Distance from nearest well- __ - -Dengtc offrom each line ation_--=------ Width of trench est lot line---------------� ❑ Number of lines----------------------------------- Type of filter material---------------------- Depth of filter material----------------------- F . t ------------------------ Remodeling and/or repairing (describe):-_____--- --------�" 4 ' -----------------------------------------------------"-,.--------- --------------------- < ----- -------------------------------•-------------- i I hereb certify that I have prepared this application and that the work will be done in accordance with San Joaquin County s ordinances. State laws, and rules and regulations of the San Joaquin Local Health District. s -_. (Owner and/or Contractor) -------------- ---- (Signed)- - (Title)--- "Z-7— Ti+le) ----------- (Plot plans, owing size of lot, location o system relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------ ---- � = -------------- DATE-----�_ --=�j�---;-- •--�`- ----- REVIEWED -------------- DATE----- ------ ---------------- ----------- REVIEWEDBY DATE---------------------------------,-------------------•------- BUILDING PERMIT ISSUED------------------------------------------------------------ ------- ------------ ------ -- ---- - ------ ------------ --------------- - ---- - - Alterations and/or recommendefions---------------------------------- f - - jj 41 l ---- ; A .r ?+{,��------ ti -------------- ------------- T-�- v .,,,'1 ''. v ----------------------------------- --------- ;-------- W 114 =---------------- - - _ - �------------------------------------------------------- --_-------------- ------------------------------------------------------------------------------------------------ 615& � . - -�-------(Date FINAL INSPECTION BY--------- --------- ------------------`�--j------------- PERMIT No----- - ISSUED---- ----- T--- /j€/ Date----------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 1 Stockton, California ES-9---2M 9-50 W=1639