255 - Laserfiche WebLink

Home Browse Search

S- J_ APPLICATION FOR SANITATION PERMIT �. (Complete in Duplicate) Application is hereby made to the San Joaquin Local Health District for a ermit to construct and install the work herein described. This application is made in compliance with County Ordina ce Q. 9. (Y� A JOB ADDRESS AND LO TION--- ----- - --- - -- --------------------------- Owner s Name_____ _ _e----_ _. 0 1�'.__t __el ___ _.____ ___ Phone_____ Address-------------- ------- `------ 4�------------------------------------------------ - - ----------------------------------------- Contractor's Name iz�i {J � `� -�='-`-`------------- ----- ----------------------_---- Phone�:��,� �C_-_7... Installation will serve: Residence`' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: If Number of bedrooms JZ Number of baths Lot size___ y c w Water Supply: Public system Community system ❑ Private ❑ 1 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 well_________________Distance from foundation__------------------Material____________________-______-_-__________•_-_. ❑ No. of compartments--------------------------Capacity-----------------------Size--------------------------------Liquid depth-------------------- i Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material------------------------------------- 0 ____- _----_________________❑ Size: Diameter-----'--------------------------------Depth---------------------------------------------------- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ F Distance to nearest lot line________________________________________________ f r Seepa a Pit: Distance to nearest well_= _-;__~_^� ._--__Distance from foundation____ _.___.Distance to nearest I&�ne----fd__-___ Number of pits_...___, -----------Lining material_ -__Size: Diameter._�,?.`------.Depth/ _____________________ Disposal Field: Distance from nearest well——_,_ ____.Distance from foundation-----J_ to nearest lot line----/_0...... Number of lines__---_______ -----------------Length of each line-----c,l_�3__-___-----------Width of trench______, q_-_-________----.__ Type of filter ma terial__f _ _____Depth of filter material_______�_�___::__ F Remodelingand/or repairing (describe)------------------------------------------- _-------------------------------------------------------------------------------------------------------- --------------------------------------------------------------= '----------------------------------------------------------------------------•-.---------------------------------------------------------------------------- _______________________________________________________________5----------------------------------------------------------.--_----__________________________.________________________________________________-_--_____________ 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) __------,S_�r ---------------------------------------------------------------------;------------ /or Contractor) BY: (Title)_ ✓n'J ------------------------- (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------------- ----------------------------------------------- DATE--------------- ------- I-- ------------- REVIEWED BY--------------------------------------------------------------�------- -- ------------------------------------ DATE--------- '�-J -> ---------------- BUILDINGPERMIT ISSUED_____________________------------------------------------------------------------- . DATE----._-_-___--_____-- Alterationsand/or recommendations------------------------------------------------------------------------------------------------------------------------------------------------------------ -----•---------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------•-----•-------------------------------•--.-......... -----------------------------••-------------------------------------------...-----------------------------.------------------- ------------------------------•----------------------------------------------------------------------------------------------------------------------------•------------------------------------------------------------------ ------------------------------------------- -- r �- { ----- Date FINAL INSPECTION BY: y��'. er► '------------------------ Date -------------------- PERMIT No.---�-�--�-- ISSUED--------------------------� (Date) � ��/e- /J_ ----�� Date---------------//2 s s�---------------------- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton,,California ES-9-2M 9-50 W=1639