Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION ' __-_-_~____ ___________ �-�-----__-} q�_�-_ ---------------------------------------- <br /> ------------- <br /> -_ <br /> Owner's Name---------- -� `� �' '�L ----- ;�------ P on. --- .�. <br /> ----- <br /> ------------ <br /> Address--- /-'"a--'---q----W' 9f .e -_�, <br /> ------------------------------- - ------ <br /> Contractor's Name--,:77r_ � Vic- `�= ±— ------------------------------------- Phone--- �----- <br /> Installation will serve: Residence,9 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: Number of bedrooms Number of baths Rn Lot size__✓--,�/______-___ <br /> --------------------------- <br /> Water Supply: Public system '. Community system ❑ Private ❑ <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe X Hardpan ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if ublic sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well_ 01'1-e----Distance from foundation--i�_-4"---M terial- �e_c---------------------------------- <br /> No. of compartments-_.---_�"--_-_-_--_-_Capacity--- -_----___Size; - '-5 -----Liquid depth-�-Z=' <br /> &2"d-er <br /> Cesspool:r€, Distance from nearest well-----------------Distance from foundation:---_----_---___.Lining material----_--------_----------------__--_-. <br /> ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------- <br /> Privy: Distance from nearest well-----------------------------------------------=--Distance from nearest buiHing------------------------------------------ <br /> El Distance to nearest lot line------------------------------------------------ <br /> Seepage Pit: Distance to nearest well--- Ulf -----Distance from foundation---- ------------Distance to nearest lot line- --.._--- <br /> s --. <br /> f �Iny Number of pits--------- ----------Lining material------------------------Size: Diameter------ ------ <br /> Disposal Field: Distance from nearest well-----------------Distance from foundation---------------------Distance to nearest lot line_--_-_-_------. <br /> ❑ Number of lines-----------------------------------Length of each line------------------------------Width of french----------------------------------- <br /> Type of filter material-------------------------Depth of filter material----.-----------'--_--_ �¢ <br /> Remodeling and/or repairing (describe)-------------Za -_--_ •-®�___r__ -__ +' f"____---� <br /> 40L <br /> ---------------------------------------------------------------------•-------------------------------------------------------------------- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------•------------------------------------------------------------------------ <br /> - --------------- ---------------------------------------------------------------------------------------------------------------------------------------•-------------------•---------------------------------------- <br /> hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws,,and rules and regulations of the San Joaquin Local Health District. s <br /> Si nedIsho <br /> ��_ i <br /> ( 9 )-- "9 - t �`-`------------------------------------ ( Contractor) <br /> By - ------ - - - - ------- ----------------------------------------- ----------(Title) �`'�"*--�- <br /> (Plot planing size,of lot, location f system in relation to wells, buildings,-etc., must be .sled with this application). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------------------- ------------------------------------ DATE----- l <br /> 7 --------------------- <br /> REVIEWED BY--------------- ---------------- -------------- DATE- f` <br /> ------------------------------------------------------- - f <br /> BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE <br /> Alterations and/or recommendations:-------------------------------------------------------------------------------------------------------------------------•----------- ----------------------- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------------------------------------------------------•--------------------------------------------------------------------•---------------------------------- <br /> -----------------------------------------------------------•---------------------------------------------------- ------------------------------------------------- -------•--------------------------------------------------- <br /> PERMIT No.--�_11------- ISSUED--,A'_ 77-:�U-•-----------(Date) FINAL INSPECT]ON BY:----------- <br /> ------ <br /> �. <br /> Date --- --'- - --------------------------------------- <br /> SAN <br /> ------------SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> E5-9-2M 9-50 W-1639 -� <br />