Laserfiche WebLink
�J <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) D <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described, f <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION------ -5---0--� = �-- ------- ------( -5---------- i ' 'LrB""x'----) <br /> .` -- <br /> Owner's Name-------------0.4---___- r <br /> �,1 --------------- --------------------------- ------------------ Phone---------------------- � <br /> Address----------------•-------- r f(✓----------------------------------------------------------------------------------------- <br /> ------------------- ---------------------------------------------------I------------------------------------------- <br /> Contractor's Name___________________________ f <br /> -----------•---------------------------------- ----- - Phone a <br /> Installation will serve: Residence 2 , Apartment House ❑ Commercial ❑ Trailer Court [❑ Motel ❑ Other ❑. <br /> Number of living units: ❑ Number of bedrooms 2 Number of baths Lot size------- f� c—x;7 <br /> - •-------------------- <br /> Water Supply: Public system K Community system ❑ Private ❑ i <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe® Hardpan ❑ ' <br /> la <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No,a septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well__�A--_Distance from foundation----t�?----rMaterial------� <br /> QI No, of compartments._.___..__ ------Capacity...... --V--____Size_ ____...Liquid depth...- ------------------- <br /> ,Cesspool,: <br /> - ____-..-._•Cesspool: Distance from nearest well-----------------Distance from foundation-------------------- material___---_-------__-..-.--__-..___-.. <br /> ❑ Size: Diameter--------------------------------------Depth--------------------------------------------- <br /> "Privy: Distance from nearest well-------------------------------------------------Distance from nearest building <br /> ❑ Distance to nearest lot line__________ ry <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 /> Disposal Field: Distance from nearest well_---T�------Distarice from foundation----z­�$-------Distance to nearest lot line---- <br /> Number® Number of lines._._F...._�__.. <br /> ____Length of each li ne..,��,,_�-�------ Width of trench_----�l`C_'._.____.._ v) <br /> Type of filter material-- _ Depth of filter material._� �' ^ <br /> Remodeling and/or repairing (describe): 1 1; <br /> -------------•--------------------------------- <br /> -------------------------------------•-----------------------•------------- <br /> I hereby certif that 1 ve p epared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State mit and' gulati ns of the San Joaquin Local Health District. <br /> (Signed)________ ___---- --- <br /> ----- _"_...... .-.._-_-_....(Owner and/or Contractor) <br /> BY:-----------------------•- ----------------------------------- ---------------------------------------------------------------(Title)-- ------------------------------------------------------------ <br /> [Piot. plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application). <br /> FOR DEPARTMENT US ONLY <br /> APPLiCATlON ACCEPTED BY___... -_ <br /> -v - <br /> _ DATE--- -------- <br /> --- ----- <br /> REVIEWED BY------------•-- T ---------- <br /> ----------------------------------------- ----------------------------- DATE--------------- ------•-------- - <br /> UILDING PERMIT 155UED----------------------------------------------------------------------------------------------------- DATE <br /> -- ---------------------- <br /> Alterations and/or recommeyndations:------------- <br /> ------------------- <br /> _I3---- --=F .. <br /> ` <br /> _ <br /> L ---- --- = -------- <br /> � b _-, if d ------- ----------------------------------------- <br /> ----------------- <br /> p- . 5- <br /> .................................. x---------- -_---/W) <br /> j ------ <br /> ----------------------------------------- <br /> PERMIT Nc30 U ~� <br /> -- ED_ - ; , ---------(Date) FINAL INSPECTION BY:________________________ <br /> F! <br /> Date------------------------------ - ------------ - . <br /> r , SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> ' 130 South American Street <br /> ` Stockton, California <br /> ES-9---2M 9-50 W-46311 `� <br />