767 - Laserfiche WebLink

Home Browse Search

. APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application- is made-in compliance with County Ordinance-No. 549. :. JOB ADDRESS AN CATION- � V1 Owner's Name--------- ----- -- 4 i' -�� Phone--- f Address J-- ----------�--� 1✓ f ------- 5 ------ Address-- Rq fI7C'Vr �l �� Phone---- � � -------- Contractor's Name-------------•=----- z--n1�ate --JI-------i �l = =� - Installation will serve: Residence d, Aparf�ent House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ` Number of living units: -tA Number of bedrooms Z Number of baths �0_ Lot size--- ---- -- - ----------------- Water Supply: Public system ❑ Community sysfem ❑ Privafe4m Character of soil to a depth of3 feet: Sdnd ❑ —Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan i TYPE OF INSTALLATION AND SPECIFICATIONS: - (No septic tank or cesspool permi#ed,if public sewer is available within 200 feet.) Septic Tank' Distance from nearest well________________Distance from foundation------.-------------Material_.-_____-________-______-________-----____----------------- . ❑ �. No. of compartments------- Capacity-------------------Ca acit --Size--------------------------------Liquid depth------------- ~ Distance from nearest well---------------__Distance from foundation-------------------.Lining material-------------------------------------- Cesspool: ❑ Size: Diameter--------------------------------------Depth--------------------- ----------------------------- 'Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ Distance ---______________--_-______-_______-__--Distance to nearest lot line------------------------------------------------ A See a e Pit: ' Distance to ;nearest well,--0-:__� Distance�om foundation-_&O___-..__.Dista Distance to nearest I t li -e --- 1�z .......... ------------------ P ---- Number of pits___ __ ____Lining material fir__ /_ _ __Size: Diameter_._ Disposal Field: Distance from nearest well-----------------Distance--frorfi foundation--------------------Distance to nearest lot line___-_____-_--.___y QNumber of lines Length of each line----- Width of french----------------------------------- .` Type of filter material___----------------------Depth-of filter material------�"�-_" ��' - /s ' f �- ' ' ------------------ -------- ------------- Remodelin a'nd or repairing (describe): - ------------------ ---------- g ' / P g I R ---- ----•-------- - - ------------------- --- -----—f------ "a' `�•` , er-------- Q _ `_c `=== ------------- • . - ------------------- I by ---- -- prepared application I hereby certifythat I have re aced this a lice+ion and that the work will be done in accordance with San Joaquin County ordinances, Sfa laws, and rules d regulations of th 5an �aquin Local Health District. ^� t a •� aC - f -------------------- --------(Owhe and/or Contractor) (Signed)-------•--------�--- ,� ------------------------- R. C _ .L g' u (Title)---t�' t Plot plans, showingsiz��t, location of system in relation- o wells, buildin s, etc., must be file with this application). �. OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------ -- -- -------------------------------------------------------------------- DATE I ,--------------------------- ------------------------------------------ I REVIEWED BY----------------------------------------------------------------------------------------------------------------------------------------------------------------- DATE------------------ .= -------- ---------------- BUILDINGPERMIT ISSUED--------------------------------------------------------------- ------ DATE--------------------:'----------------- ------------------ Alterations a ------------------------------ ---------------------- recommendations----------------------------------- -------------------------------•--------------------------------------- �. --------------------------------------------------I- ------------------------------------------------------------------------------------------------------------------------- - ---------- ------------------------------------------------------- --------------------- ---------------- --•----------------------------------------- / 7--------- ISSUED------ -a -;f•------------(Date) FINAL INSPECTION BY:------- W/----Y------------------------------- PERMIT No.__; ____-__ '] f -------------------------- tiDate--------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California E5-9-2M 9-50 W=1639