733 - 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. x JOB ADDRESS AND LOCATION +---- °f--14 --------- ---- ------------------- Owner's Name------------�`--d-=-'-------�I 5 ------------------------------------------------- ---------------------------- Phone e°Z '� 4 D -- ------------------------------------------------- /-hl-�' Address ------ S --- Contractor's Name------------- , -------------------- ----------- Phone----------------------------------- ---------------------------- ------------------------=-------------------- - Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ;S "u eX Number of living units: ®-. Number of bedrooms P Number of baths [4 Lot size_________ -------------------- Water Supply: _ Public system Community system F1 Private ❑ 4 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ : bay Loam ❑ Clay ❑ Adobe Hardpan' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i Septic Tank: Distance' from nearest Distance-from foundation-------.��0_.___.Material_______ O. --- No. of compartments---------7___3-----Capacity---� QD �-Size_-- 13 Liquid depth--------�--------------- V Cesspool: Distance from nearest well________________Distance from foundation___________________ Lining material_______________________________-____. ❑ Size: Diameter--------------------------------------Depth--------------------- ----------------------------- _Distance from nearest building - Privy: Distance from nearest well-------------------------- --------------- g - - ❑ is an e to nearest lot line------------------------------------------------ Seepage e Pit: Distance to nearest.well_____-Q__.-----------Distance from fou dation_.__-r�_�___--.Distance to nearest lot line__�>�.-.___-_ ® Number of pits____.-_!_____________Lining material � 6/4 -.-Size: Diameter_______!1�_ _-______.Depth---_____�a�_y__. Field: Distance from nearest well.-__'� Ql____Distance from foundation_____��___---Distance to nearest lot line __/ ------- DisposalNumber of lines------------J--------------------Length of each line Type of trench__--___ - -__------------_-- Type of filter material��'_ �-lY0G1k-Depth of filter material____�q------------ Remodeling and/or repairing (describe):------------ = '1_[tQ: l-fal_✓__------- (`- t" 5��/ 'i------------------ --------------------------------- -------------------------------- v ------------------------------------------------------------------------------------------------------------------------------------------ -------------------------------------------•-------------- ---------------- - ----- --------- ----------•---------------- --------------------------------------------------------------------------------------------------------------------------------•--•--------------- I hereby certify f hat I have prepared this application and that the work will be done in accordance with San Joaquin County t ordinances, S+ a Iaws a le and regulations,of the San Joaquin Local Health District. t I (Signed) r -----------(Owner and/or Contractor) --------------- ---------------------- ------ Sy:----------------------------- - ---------------------- (Title) -- - - - - - - - - -- (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be fled with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---=----------- ----------------------------------------- DATE 0r ---------- REVIEWED BY------------ ---- --- DATE------------------------------------------------------------ -- ------------------------------------------------------------------------------------------ BUILDING PERMIT !SSUED--------------------------------- --------------------------- ---=----------- - DATE--------------- es a / -t---4i::I�i:----------------------- Alferalions ---- ---- - Alteralions and/or recommends+ions_______________ �_ _s�_________-- � j-----rf ---'----' _------------1 -°� - -- - �3® �' .-�-y'e ----- -- -- ---------------------------- ----------------------------------- �--------------- -------- ----------------------------------------- ---------------------------------------------------------------- ------------------------------------------------------------------------------ ------------------------------------------------------------------------------------- PERMIT No. 3------- ISSUED ---------3 v Date FINAL INSPECTION BY:_________ -- ---�------------------ e:------ �. Date------------------------ -------------------- �- 3 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street t Stockton, California 5--9-2M 9-50 W-1639 v _