Laserfiche WebLink
.4 7 <br /> APPLICATION FOR SANITATION IPERWIT "k <br /> (Complete in Duplicate) Xcl7e),,- <br /> Asj,*tion is hereby made to the San Joaquin Local Health District for a permit to construct and insta4l the work herein <br /> I. leis application is made in compliance with County Ordinance No. 549. described. <br /> til <br /> JOB ADDRESS A,� CATION----- /I ------- <br /> Owner's Na e —---------- ---- - ------ <br /> .Address---- _Bft <br /> ---------------- ----------------------- ----------------------------------------------------------------- <br /> --------- -------------------------------------- <br /> Contracfor's Namee <br /> ----- <br /> - -- —- - ------ - ------------------ ----------------------------------------------- Phone-- <br /> Installation will serve: Resiclenc!�Apartment House El Commercial [] Trailer Court F] Motel E] Other Ej <br /> Number of living units: Number of bedrooms gn Number of baths Ej Lot size:/_3-- -2------ ---- 95 <br /> __0----------- <br /> L 1 _ - <br /> Wafer Supply: PUL Community system F] Private <br /> Character of soil to a depth of 3 feet: Sand E] Gravel ❑E] Sandy Loam E] C�ay Loam 21"Clay El Adobe E] Hardpan Elql. <br /> TYPE 00 INSTALLATION AND SPECIFICATIONS: <br /> (No sepfic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank-- Distance from nearest well--(Distance from foundation--_ _ --------- ----------- <br /> No. of comparfments---- Capacify__$ Q' _o----Size------- y..........Liquid depth____.____ --_______ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation------- ----------Lining material------------------------------------- <br /> I-] Size: Diameter------------------------------------ -Depth-------------------------------- -------------------- <br /> Privy- Distance from nearest well_________________________ _________________Distance from nearest building_;_-____---_______---_________-____ <br /> ❑ <br /> uilding---------------------------------------El Distance to nearest lot line <br /> Seepag Pit: Distance to nearesf/ell----------------------Distance from fourclati -—---- Dj'5 tante f----- o <br /> nearest lo <br /> Number of pits______ ---------------Lining Diameter ----.Depth---- <br /> Disp I Field: Distance from nearest well___- - _._.Distance from founclation___?_� to nearest lot line <br /> � -_47------------ <br /> Number of lines----------- X- --------------Lenvh of each line----------------t—' Wiclth of trench----_------_---11 _--------- <br /> *,Type of filter rnaferial-____26�_ p t h of filter material___-K___1. ;Z_ <br /> Remodeling and/or repairing (describe)--------------- ---------------------------------------------------------------- <br /> ---------------------------------------------------------------------------------- -------------------------------------­--------------------------------------------------------------------------------------------------- <br /> / ,,1 <br /> ------------------------------------- ---------------------------------------------------------i------------------------------------------------------------------------------------------------------------------------------ <br /> ----------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> I hereby certify that I have prepared this application and fhaf the work will be done in accordance with San Joaquin County <br /> ordinances, State aws, and rules and regulations of the San Joaquin Local Health Disfricf. <br /> (Signed)------ ---I --------)------------------------------------------------------------------____(Owne, nd/or Contractor <br /> i V, <br /> BY:------ ------------------------(Title) <br /> ------ <br /> ................... <br /> -------- --- ----------- r <br /> ----------------------------------------- ...... <br /> t <br /> (Plot plans, showing size of lot, location of system in relation to wte s, buildings, efc., must be filed with this application). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY__:_,___.._._---_.-__._ ? _6 <br /> --- -------------- DATE-------- <br /> REVIEWEDBY --- ------ --- -------------- DATE___- ----------------------------------------------- <br /> BUILDING PERMIT ISSUED--------------------------------------------------------------------------------------------------------------------- DATE------------------ i <br /> Altera+ions <br /> ATE­---------------- <br /> Alferations and/or recommendations:-------- - - --------------------------------- ---------------------------------- <br /> -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------;---------------------------------------------------------------------------------- ----------------------------- -------------------- ---------------------------------------------------------------- <br /> _­----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - <br /> ----------------------------------------------------------P�------------------------------------------- ------- ----------------------- --------------------------------------------------------------------- <br /> PERMIT o, - ISSUED---- -- INSPECTION BY,-,,.-- <br /> N .3__7------------(Date) FINAL <br /> .0 <br /> Date---------- . ..... --- --- - -- ---- ----------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> FS-9-2M 9-50 W-1639 Stockfon. California <br />