201 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT '' f (Complete in Duplicate) made to th S n Joaquin Local Health District for a permit to construct and install the work herein described. . Y T `de in compliance with aunty O din?No. 549. ------------------------- J N-- ----- ----- ----- --- -- .� -� - -- --------------------------------------------------------------------- Phone__ . d .- .� ----------------------------------------------- ----•------------------------�---------- n - Name- �-�-•- - - ---- • -------------- --�"'=L,:. ---------- - --------------- Phone_ :_��---- --f------ .Al serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other , .tuber of living units: Number of bedrooms Number of baths Lot size_-- ------- Q-Q ----------------------- y Private ��` ,upply: Public system Communitysystem ❑ ❑ Adobe Hardpan ❑ :ter of soil +o a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Ciay ❑ f ,'E OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.)~�. Septic Tank: Distance from nre earest well _ _ Distance�rf-' foundation------ ---------Material.-------------- -------- / I >f° " -" Liquid depth - No. of compartments-------- --------Capaci�Yf.� .. Size--- -------�-•� N n i _-_______-_--_Distance from 'foundation------------------- material------------------- ------ Cesspool: Distance from nearest well- 4 ❑ Size: Diameter--------------------------------------Depth--------------------- --------------------- --------------------------Distance from nearest building- ---------------- Distance ----- . privy; Distance from nearest well_______________________ ❑ Distance to nearest lot line---.----•----------------------------- ------ Distance f tom foun anon-__--_� {-.Distance to nearest lot line_---_ !11 Seepage Pit: Distance to nearest well---------------------- Size: Diameter �0-__--___.Depth-� ` - 400 Number of pits.___..___-----_-__Linin mater�al. l-R- s� '► ____,Distance from foundation---_��_---__.Distance to nearest to#'line___��-___._ !a 4; Dispos I Field: Distance from nearest well------------- f-�,----Width of trench_---� --------------------- Number of lines________________ �--------------Length. of each I•sne-------� - ....... Yp • 1, --- ___ epth of filter material-------42-------- --------- Type of filter material - D p --- --- ---------------- Remodeling and/or repairing (desc�ibe}:-------------_-------_ --------- - ----------------------•-------------------------------------------- repared this application and that the work will be done in accordance with San Joaquin County I hereby certify that I have p ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. l',-4 ------------------------------------------------------- (Signed)-----V. 44 f4 -- /or Contractor) BY: -- -----� - -------------------- (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_--_--______-----_�-�-----�-�- ---------------------------------------------------- DATE_i��` ' ------------- ------------------------•------------------------ DATE-----------DATE--------------------- --------...------------------------ -- REVIEWED BY__.--------•----------------------- -------------------------------------------------------------------------- BUILDING PERMIT ISSUED.----------:----------------- ------------------------------- -------------------------- ---------- Alterations and/or recommendations:--------------------------------___ ------------------------ -----------------•--------------------------------------------- --------------------------- ---------------------------------------------------------------- ---------------------------------------------------- I f ti ---------------- ------------------ -----------------------------------•-----------------•--------------------------------------------------- l ------------------- ---------------------------------------------------------------------------- k -------(Date) FINAL INSPECTION BY---------- ---- - - ------------/--,,,---7------------- PERMIT No-,2--d-./- ----------- ISSUED pate----------------•----- - -- SAN JOAQUIN LOCAL HEALTH DISTRICT ' 130 South American Street Stockton, California 1 ES-4-2M 4-50 W=1639