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 des <br /> App� Y q � p <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION. 10 i .................................... ............... <br /> Owner's Name ,t ------- -- Phone -- <br /> Address <br /> s <br /> f <br /> Address_ --- <br /> A D <br /> Contractor's Name !.K f '4-` O+.r+.' Phone- .": ------- -- <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other ❑ = <br /> Number of living units: ❑ Number of bedrooms ❑ Number o baths Lot size...�__a ,.G,e;.................. y4,11 <br /> ,,, <br /> AM <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 Hardpan <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well �----------Distance from foundation-----'R <br /> � ----Materia---- <br /> Capacity-_/_4 <br /> Size _ l____ SG.-.Liq� <br /> uid deph__-. !41i <br /> - <br /> No. of compartments._.___ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-----•-•___-___________---------_,. <br /> ❑ Size: Diameter-------------------------------------Depth---------------------------------------------------- <br /> • <br /> Priv Distance from nearest well--------- Distance from nearest building <br /> ❑ <br /> Distance to nearest lot line---------------___._:Y _.____.__.,........... t,, <br /> Seepage Pit: Distance to nearest well______________ ______Distance from foundation....................Distance to nearest lot line.. <br /> ❑ Number of pits----------------------Lirur►g material---------------_-----Size: Diameter-----------------------.Depth......................... <br /> Dispos I Field: Distance from nearest-,W . -=----------Distance from foundation------1.40.......Distance to nearest lot line____-� <br /> Number of lines._. ,!'__ Length of each line--------- .-1_t _�.....Width of trench------,�_I�.r!__..-_ <br /> Type of filter material.µ -_-j---,/ _'Depth of filter material------;Lf__'_'---- <br /> Remodeling and/or repairing (describe):------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accoPdance with San Joaquin fou <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)--•- W_ . ..-------11�"--.I&'.'.''-------------------•-------------------------------------------------..(Gwrer and/or Contract* <br /> -- = -------------•(Title)--- -'�t'r'ry <br /> -------------­- <br /> By: #. <br /> (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------- ----- -------------------------------------------------------------------_-• DATE------- . � <br /> REVIEWEDBY.................................. --------------------------------------------- -------------------- DATE--------j>���---------------------------- <br /> BUILDING PERMIT ISSUED......................------_---------_---------------------------------------_------------- DATE------------------�----------------- --------- <br /> Alterations <br /> --Alterations and/or recommendations__ ______________________________ <br /> -------------------------------------------------------------•-------- <br /> ______________________________•___--_-_---------__--___-__-----------------_-_-___--._-_.-_--_.---•----_------.--_•____-----•_-----_--------------------_--___--------••----_-_-•---___--------_----___-_--------___._-------__ <br /> -----------------------------------------------•-_--___-__------_-_-_-_---------------_-__--_---__---__--__----------_•-______________----___--_---__------_-_-__-____-__-----____----_____-_--_-------_-_--__--______-_...... <br /> ................................................................................................................-________-__________--_______._--._-.__.____-___.--____._--__-_..___-__..-----__-------_-___---------_-...-. <br /> PERMIT No--- -- --- --------- ISSUED---- --1_�j_,�"�---__---(Date) FINAL INSPECTION BY:_-._.___-_____.__-_._._-.-____..___--..--...._.----------_-_--- <br /> Date---------------------- <br />