481 - 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. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS LOCATION_ - \ jx----------- --gply&--- ie__�, ---------NC_ Owner's Name_------ Q_f�J11C�--------- �q -- ------ ------- -------- -------- ------------------- -- Phone- Owner's --- ------- �+ d_1 6-�//_4"�------------ i QQ �• �,,/ �,/ �-+----- - -------- ---------------- - -------- -------- ------Phone- ------ ------------------- Contractor's Name------- -4- � �ull-y.7--F l------4-�C_ ' _D S �� - Installation will serve: Residence Apartment House E] Commercial El Trailer Court [-] Motel El Other ❑ Number of living units: Number of bedrooms J& Number of baths [t Lot size__ _- - Water Supply: Public syste23(feef: Community system E] Private F-11-----�(___f Character of soil to a depth Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Gay ❑. Adobe Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: O (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well------------------Distance from foundation------------------- Material----- ------- ------ ------- ------- I ❑ No. of compartments--------------------------Capacity-----------------------Size--------------------------------Liquid depth-------------------- Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material___-__--___--___--___-___.- El Size: Diameter---------------------- ------ -------Depth---------------------------------------------------- Privy: Distance from- nearest well_______________" _______________________________Distance from nearest buildin ❑ Distance to nearest lot line-- g ------------------------- --- - Seepage Pit: Distance to nearest well -------------Distarrce from foundation--------------------Distance to nearest lot line_______________ ❑ Number of pits______________________Lining material----------------------- size: Diameter-----------------------Depth------------------------Disp�[ Field: Distance from nearest well*--W;/JDistance from foundation_16,Q Number of lines �11!' s�� Distance to nearest [ot line__-�__ _��_____________Length of each line / ___-- `_--___.Width of trench__•__�- __--�__ # Type of filter material_ ____PAR --Depth of filter material_/Z-__----_ " Remodeling and/or repairing (describe).,--- ------------------_---- describe):___ -- -------- --------------------------- --- --------- - --------•---------------•---------- pp -- --- - --- ----------- --- -- -------- ------------- ------ ---- hereby certify that I have prep this application and that the work 1 be done in accordance with San Joaquin County ordinances, St a laws, d rules an ' reg ations of th an Joa in Local Ith District. (Signed)----- L --- ------ ---- -- (Owner an r�Uonactor) BY:------ s y - ------- (Plot (Title) a plans, sh wing size of lot, location of system in r la+ion to wells, buildings, etc., must be filed th this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------------- -- REVIEWED BY J DATE- - �� f ------- DATE_ ------------ BUILDING PERMIT ISSUED = - -------------------------------------- ----------------------------- DATE------------------------ - --------- A terations and/or recommendations: ------------ ---------------------------- ----------------------- --------------------------------------------------------------------- ------- ------------------------------- ----------- PERMIT No.- /--------- ISSUED------ -fit- 6-1 --19 ------- ) FINAL INSPECTION BY:----,/// «' Date i� 3 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ES-9--2M 9-50 W-1639 Stockton, California