614 - Laserfiche WebLink

Home Browse Search

- , APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) 1` } Application is hereby made to the San Joaquin Local Health District for a permit to construct a4inil the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION-----------56.05--E_ Ka-12a----------........ 1' Owner's Name------------11 Xont-ey------------------------------------------------------------------------------ ------------------------------ Phone---l}-6-0.1€2---------------- { Address-•-----------------560x--E-.-- Ia-in Contractor's Name----------------D0.1tS-------------------------------------------------------------------------------------------------------------- Phone-----3--3955----------- Installation will serve: Residence Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other'[Z Cabins g Number of living units: umbberr o?bedrooms [Z/'Number of baW Lot size_____2-QQ_-X-2Q4------------------------------ Water Supply: Public system ❑ Community system ❑ Private Pq Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ® Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public.sewer is available within 200 feet.) Septic Tank: Distance from nearest we]---------50---Distance from foundation---l0________--.Material----0Q eat-briek_________. pCapacity-----80-05 e ----Liquid depth--4"-&'J-. ------ L' [3 No. of com artments-----_-_-2----__-______ ---------Sizett�� S0? gad Cesspool- Distance from nearest well---------------_D.istance from foundation----------_---_ __,Lining material____-----___-___--.-----:__---------. ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------- Privy: Distance from nearest well_,------------------------------------------------Distance from nearest building---------------_______-----_-_ �* ❑ Distance to nearest lot line-------------------------- -------------------- Seepage _______ _________Seepage Pit: Distance to nearest well-100 Distance from foundation--.---8.. --- ..Distance to nearest lot line------- 5- ® Number of pits---__Z--------------Lining material___brijak-----Size: Diameter---------- - ---.Depth___------201----__---______ ..Disposal Field: Distance from nearest well------------------ from foundation--------------------Distance to nearest lot line-___--_---------- COriYiECt with Number of lines-----------------------------------Length of each line------------------------------Width of trench----------------------------------- . soIid line Type of filter material-------------------------Depth of filter material----------------------- Remodeling and/or repairing (describe):----------_rept,jx_Lng---"----jnstallin&-new-_-_D-eSLent-brit ali-_S,eP zC___i. lk on--the---f_aur----aab-inz---to---�-ake---�1as-�---a�---pre•sent__wooden_�ank-_whish--s rotted--out-, install-in&-neer---v-er-new -d}ra,in---on'hause---s-yet-e_m---a xe---eo ect_ h--- ed d I n ---to a1.d----leach--dr-air,.------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) De 1 --------------- ----------------------------------------------------------------------- (Owner and/or Contractor) By:---------------Per_ry- Wartk�an��,�1 ---- ------ -- - - - --�- ------(Title) {3wner-L� r' (Plot plans, showing size of lot, locafion of system in relation to wells, buildings,-etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- ------- ------------ ------ --------- DATE--------------- `=t,� ------------- REVII WED BY ------ ------------------------------------------------------ DATE-_---------------------- -------------------------- BUILDING PERMIT ISSUED-------------------------------- ------------ -- ------------------------------------- DATE `- Alterations and/or recommendations-------------------------------------- - ---------------------- ------- ---------------- --------- __ _ ----------------- 9---- IV [ '� ---------------- --------------------------------------- - PERMIT No._j6�1--�/----- ISSUED__--_- _( -- - ---- Date) FINAL INSPECTION BY: ----------------- -- -------------- ----------------- � Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Igr frf Stockton, California 'M 4,b39