777 - Laserfiche WebLink

Home Browse Search

F APPLICATION FOR SANITATION PERMIT 717 (Complete in Duplicate) Application is hereby madeo the San Joaquin Lo This application is made in cal Health District for a permit to constru compliance with County Ordinance No. 49, ct and install the work herein described, JOB ADDRESS A D LOCATION__._ _ __"__ - a cF f ------------- wner's Name -- ------------- ----=-- -_4---------------------- " d C Address_.---•-- -- -- --------- ------- ---------------------------------- Phone---------- ------- ontractor's Name. - ------ ---------------------- ------------ --- ----- P Installation will serve: Residence ---- - ----------------- ------------- --------------------------------- Phone---------------------------•------- Apartment House ❑ Commercial e Number of livingunits- +e,5 ❑ 'Trailer Court []ii Mot I ❑ Other ❑ umber of bedrooms � %'Number of baths [b Lot size__-_{_�__ Water Supply: s stem ---------------------------- PublicY :��Community system ❑ Prive e;0 Character of soil to a depth of 3 feet: Sand ❑ Gravel1Loa ❑ 5andy m ❑ / Loam I 00 TYPE OF INSTALLATION AND SPECIFICATIONS: '-. m ❑ Clay ❑ Adobe Hardpan ❑ (No septic tank or cesspool permitted if public sewer is available within 200 feet. t ) Septic ank: Distance from nearest Well_______________•_Distance from f u ..ation___.._!-_0 �-Ma#eri Cess ooLr No. of compartments---__-___-"Z_-------_Capacity.__._ �f 1 Size_��._ ___h iquid depth------- -----p Distance from nearest well________________"Distance from foundation----------.__-_____.Lining material___________ n ❑ Size: Diameter________________ Dept -------- Privy- � Distance from nearest well_ � -""`"�__b`isterice from nearest building ' ❑ Distance to nearest loft line----------"____-""_ g---------"------------- - eepage Pit: Distance to nearest well_--__-__-------------Distance from foundation___-____ ❑ Number of pits---- -----------Distance to"nearest lot line_______________- ------------------Lining material_______________________Size: Diameter_-____-_____"""_" Dispos Field: Distance from nearest w Il "-- - -----.Depth----------------------" ______.Distance from foundation _ �_� Distance to nearest Iqz}aline--- Number of lines--------- Length of each line________ Type of filter materi _ Width of trench_______ ' Depth of filter material----------� ------------------- Remodeling and/or repairing (describe):____________________" _ - r ---- ----------------------------------------------•--------------•--------------------- ---------------•-------- --------- I hereby ce .y that I have pr�epared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta .aws, and rules aC11 regulations of the Sah .�oaquin'`Local Health District, tY (Signed) ,.� '-o �- TM - ------ ------------------------------------------------,-------------- r By:____"______--- (Owner and/or Contractor) ----• -------- ---------=------------------------------------------------ -- - - -- -- -- --- - -------(Title)-----------------------------------•-------•---•---•- of plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application).w FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_________________________ eW REVIEWED BY------------------------- DATE 'J.,"� BUILDING PERMIT ISSUED_ ----------------------- --------------------- DATE - ----------------------- ----- Alterations and/or recommendations------------------------ ------ ------------- ------------- -------------- DATE----------------------- --------------------------------------------------------------- --------------------------------------------------------------------------- ------------- ------•---------------------------------------------------•------- ---------------- ------------------------ PERMIT No.-77-7 ------ ISSUED ISSUED------- ------------ `!` r --------(Date) FINAL INSPECTION BY:-------- / jV_d_ ______-_ " p� ,.- -------- Date - +A_._""'s SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street E5-9-2M 9-50 W-1639 . Stockton, California