683 - Laserfiche WebLink

Home Browse Search

5 I APPLICATION FOR SANITATION PERMIT [Complete in Duplicate) An is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. Thisapplication is made in compliance with County Ordinance No. 549. {{�� JOB ADDRESS AND LOCATION --5aY4 --------t ------- Gt�t '----------------------------------------------------------- Owner`s Name----------------- -- ------�Q--'S � -—S- -f------------ ----------------- ------------- Phone_ - ">- 0---- t Address------- .c.f ---------------�-------------------------------------------------------------------------------------------------------------------------- ------------------------------- ------- ----- tH� Contractor's Name---------------� --- ------f- ----_--------=------�-- Installation will serve: Residence IX Apartment House El Commercial ❑ Trailer Court E] Motel E] -Other ❑ ------------ Number of living units: [�] Number of bedrooms Number of baths M Lot size--------__ ---- Water Supply: Public system Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand F-1Gravel 171 Sandy Loam ❑ Clay Loam ❑ ,Clay E] Adobe —1 Hardpan ❑ ' TYPE OF INSTALLATION AND SPECIFICATIONS: Y W (No septic tank or cesspool permitted if public sewer is available within 200 feet.) w Septic Tank: Distance from nearest well-----------------Distance from foundation_________-___i:__:.Material__________-_---__________--____________--_______- ❑ No. of compartments-------------------- ----_CaP acitY--=------------- - Size---------------------------------Liquid depth-------------------------- Cesspool: Distance from nearest wellDistance from foundation_____:___"_______--_Lining materia________________________ _ --------- Size: Diameter--------------------------------------Depth------------------------------------------------------ Privy: ------------------_- ------------------------- -Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---------------__________________________. ❑ Distance to nearest lot line------------------------------------------------ I Seepage Pit: Distance to nearest well______________________Distance from foundation_---______ _---___.Distance to nearest lot line----------------- El Number of pits----------------------Lining material------------------------_Size: Diame �________---____-- ----.Depth �- ______Distance to nearest lot line_-_15-______-__ If Disposal Field: Distance from nearest well________________Distance from foundation_____-� Number of lines------------- -----------------(,Length of each line--------4J--O----- -----.Width of trench------- — ---------- Type of filter material_"R_A_9+_<�A. -Depth of filter material---------+_ -=--- Remodeling and/or repairing (describe)---------------------------------- '--------------- ---"`•--- - ----------- -------------------I---------- ----------------- ----------------- ------ --- ---------------------------------------------------------------------------- ------------------------ ------------- - ------- ------------- -- - - I hereby certify thaW11,hhavepr red this application and that the work will be done in accordance with San Joaquin County ordinances, State,,laws, aregulations of the SanJoaquin Local Heal#h District. `'-----------------=--------------------------------- and/or__Own re ntrac#(Signed) Ag - ---- = --------------- r - " ., --------- (Title)_BY=------------r - [Plot plans, showing size of lot, loca+ion of system in relation to wells, buildings; etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY___________ __ " --- -- -` = DATE---------- - =a I DATE------------------------------------------------ BY------------------------------------------------------------- =---- --- ------------------- ---------- BUILDING PERMIT ISSUED-------------------------------------------------------------- - ------- ----------- ------- DATE------------------------------------------- -------- Alteratio and/or recommendations:_------- "_---1 J p =-------- ------------------------------------� ---------------------- --------- - ------------------------------ r ti g� _ +G7 r 6 0 3 -t-PIX-1_-------(Date) FINAL INSPECTION BY-------------------------------------------------------------- 1 PERMIT No. ---- ISSUED_ � --_7- ---- --------------------------------------------- - = ` ate----- ------------------- v SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES--9-2M 9-50 W-1639