Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT r <br /> (Complete in Duplicate) <br /> Application <br /> p Is here:�cl to <br /> T I lic tton is I"e to e San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> applicationn compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION___________ <br /> ---------------------------------------------------------------------- <br /> -ile-k-4 4/----- <br /> Ow' ner' Phone--- <br /> Owners Name_. ------ <br /> Address------------- ------- <br /> ------------------- ----- -----------1 ----- ---- -- <br /> Contractor's Nam' e--------- -------------------------------------------------------------- Phone--- <br /> ------- ---- <br /> Resid' <br /> Installation will'serve: Residence Apartment H e E] Commercial E] Trailer Court E] Motel El Other <br /> I p <br /> Number of living units: Number-of bedrooms Number of baths [/ Lot size-------- _X - --------------- <br /> !j il ' 'P_-0 _6--- ----- <br /> 'W.afer Supply. Public syst6m ❑ Community sysfem.Ej Private <br /> 'Character <br /> K /. I ?( <br /> Charact6r of soil to a depth of 3 feet: Sana E] Gravel 0 Sandy Loam E] Clay Loam 0 Clay E] Adobe Hardpan E❑I�' k <br /> ' <br /> TYPE/'OF INSTALLATION AND SPECIFICATIONS: <br /> No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> tic Tank: Distance:from nearest well-----------------Distance from foundafio' n--------------------Material---------------------------------- <br /> No. of compartments--------------------------Capacity-----------------------Size--------------------------------Liquid depth-:------ --------- <br /> ol: Distance from nearest well-------------- <br /> ��Spo ---Distance from foundation_ ______-_-----____ Lining material______-_____--___________-______0 <br /> Size: Diameter-----------------------------------------------------------------------------Depth <br /> rivy: Distance'from nearest well-------------------------------------------------Distance from nearest building---------------------------------------- <br /> j .��:E❑ Distance to nearest lot line_______________ <br /> .ef------------------------------- <br /> page Pit: Distancelo nearest well----5Z 1�17q----Distance�;om foundation----;Z$7____.Dist§nce to nearest lot line <br /> Numberof pifs------/-------------Lining material---LjAj*1iC_k__Size: Diameter___Z--(JDL--------Depth-------4--- ----------- <br /> ispo al Field: Distance from nearest well --.Distance from foundation_ tx_/------jDistance to nearest lot I' <br /> li Number of lines________ Length of each line---.S---C�' Width of trench______60' -------- <br /> ---- ------ <br /> DeQfh of filter material-------/_O----------- <br /> Ii Type o� filter material____1)2,--?4 <br /> ReLdeling and/or repairing (describe):----------- ---AAM..)------- ----------------------------------- <br /> --------------------------------- ------------------------------------- ---------------- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> --------------------------------------------------------------------------------- <br /> - -------------------------- <br /> T------------ <br /> t------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> I hereby certify that I la prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, Staf!ejawsand I s d regulations of the San Joaquin Local Health District. <br /> {Signed)------- <br /> 9 --------------------------------------------------------------------------[Qwjrnqr and/or Contraci-""� <br /> i <br /> By:------------ ---------o---- ---------------------_4-------------------------------------------------------------------(Title)---- <br /> (Plot plans, showing size of lot, ocation of system in relation to wells, buildings. etc., must be flied with Ais application). <br /> FOAPARTIVIENT USE ONLY <br /> ------------------- <br /> APPLICATION ACCEPTED BY---------------------------- --------------------------------------------------------7-------- <br /> - DAT <br /> -- - --- <br /> - <br /> ------ -- --- <br /> REVIEWED BY--------- -------------------------------- DATE- -- -- <br /> BUILDING ------------ <br /> PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE <br /> Alterations and/or recommendations________________________ <br /> 4'- <br /> ---------------------------------------------------------- ---------------------------------------- <br /> Fr <br /> ----------------------- -------------------------------I--------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> --------------------------------------------------7---------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> -----------------•------- ----------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> PERMIT I ------ `/----(Date) FINAL INSPECTION BY----------------------------------------•----------------------- <br /> t <br /> MNo------21--- ISSUED------__---- -- <br /> Date <br /> IE SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES--9-2M 9-50 W=1639 <br />