59 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT S (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 AND LOCATION_.�_2-. /V, F' r. n Owner's Name r i "� - ri: = ------------------------------------------------------------ - -----------2--M -�--04-t ------------ --------------- Phone ----------------- Address----------- - -/3-�---�'--------- Contractor's Name----- ,wryLp ------------------------------ ------------------------------------ Phone- Installation will serve: Residence ® Apartment House E] Commercial ❑ Trailer Court E] Motel ❑ Other Number of living units: 91 Number of bedrooms EB Number of baths ❑ Lot size______________________" ❑ ------------------------------------- ater Supply: Public system D? Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Ia 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_____----00-----_-Capacity._] ]Size----------------- Liquid Cesspool- Distance from nearestv�ell_ 1 �"" Distance from foundation'-_~/_t�-____-"-Lining material_____________________-__--- --------- ® Size: Diameter X y-------------Depth---------------- 'Privy: Distance from nearest well----------jVO7-A- -------------------------Distance from nearest building 30 Distance to nearest lot line--------- ----- "_ _____" ' ¢ Seepage Pit: Distance to nearest well---------_------------Distance from foundation--------------------Distance to nearest lot line_______________" ❑ Number of pits ---------------Lining material---------------------- Size: Diameter-----------------------Depth--------------- ---------------- .Disposal Field: Distance from nearest well------------------Distance from foundation------_________----Distance to nearest lot line________ -_____ ❑ Number of lines-----------------------------------Length of each line------------------------------Width of trench ------- � �j Type of filter material---------------------- -------- ___Depth of filtor material___________________"""_ ++ -Remodeling and/or repairing (describe):________"c{_ "G B-,�1`_ _ q� 1 I --- ----- ------------------------- ' ---p -'t"r )-� ------- ----------------------------------------------------------- � .. 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)------v�.�1�.�/��t-•.!_/-��.G-�- - .:��.. ._�,a----- - -- ----------------------------------------------------'----- (Owner and/or Contractor) $Y: --------------------------- ------------ --------------------------------------------------------------(Title)-----------------------------------.... (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENVUSE ONLY APPLICATION ACCEPTED BY--------W---V---4 DATE REVIEWED BY -- . 1�------ ------------- ' ------- - ------------------------ DATE-----/ BUILDING PERMIT ISSUED___ _. --------------------------------------- DATE------- .......... Alterations and/or recommendations:______--______________________ '---------------•------` -------------------------------------------•----------•--- n y ---------------------------- •°{i _ •• -GCS `72 T --- ------• - No._____S1--------- ISSUED-- -4----Z-----'---s'-0----(Date) FINAL INSPECTION BY.:- ------------------- - — 5 3 � ~`7 �> Date----- " -------------------------------- , SAN OAQUIN LOCAL HEALTH DISTRICT 130 South American Street ES--9-2M 9-50 W-1639 Stockton, California t