376 - Laserfiche WebLink

Home Browse Search

a : APPLICATION FOR SANITATION PERMIT /-42l D (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. _ _ 4- --- ------------------------------------------------�-` JOB ADDRESS AND LOCATION------------------------------ ------- - Owner's Name 1 ► ff% _ R�- `----------------------- -- Phone= T= -�= ' ------ r� «l Address-----------------•- 1,44 IV, ' L(Vf t�f_A, -----------°��----�'�.-f--------------------------- k Contractor's Name------ ` ' �� _t l-/ --- -------------- ---------. _ f__-------------------------- Phone ---------------------- Installation ------------_- - Installation will serve: Residence _R Apartment House ♦] Commercial ❑ Trailer 'Court ❑ Motel ❑ Other ❑ Number of living units: ❑. Number of bedrooms p, Number of baths FL] Lot size_____'�+� - __ ---- ...........----------- Water Supply: Public system Community system ❑ Private ❑ Character of soil to a depth of i3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 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--------------------------Capacity----------------------Size---------------------------------Liquid depth-------------------------- Cesspool: Distance from nearest well_________________Distance from foundation______________.__.Lining material__________.._______________________. ❑ Size: Diameter--------------------------------Depth----------------t----------------------- - - ._ . _ . Privy: Distance.from.nearest well =_-_-__:-_ ____________________________Distance' from nearest�buiiding----.__________________________________ ❑ Distance to nearest lot line________________________________________________ Seepage Pit: Distance to nearest-well___,r�_ ____Distance from foundation"-='? +. __.Distance to nearest lot line-- :m7--_ Number of pits__ _____,__Lining matecial: :__'k_'_____Size: Diameter_=� ' "--_______.Depth:_._.ffi _________________ _...Disposal Field: Distance from nearest well---------------------Distance from foundation--------------------Distance to nearest lot line_________-_____- F ❑ Number of lines-----------------------------------Length.of each•line-------------------------_----Width of trench----------------------------------- Type of filter material-------------------------Depth of filter material--------------__--- r�1 Remodeling and/or repairing (describe:-'---- --- ------ r"' '�-------------- �a �, - �- t --•-------- --- --- -------- -------•-------- -----------------`- - ----- -- ------- -------- ------------- - 1s --------------------------------------------=---=-----— --------------------------------------------------- f/ 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------------------ - -------------- -- -- Owner and/or Contractor B . �1 l 'I; -_�' f�` � � � a f`..{ Tit j1-ell �i� ` • G a rr 3 By - - -----------�_; - ------ --- — - ---------------- )� d (Plot plans, showing size of lot, location of system in.relation+o we[is,.buildingi. a+c., must be filed'with ,this application). - FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------------------- > - DATE- -------- REVIEWED BY--------------=-------- --------------------- - -- - DATE ------/__--- ---- BUILDING PERMIT. ISSUED------------------------------------------------------------------------------------------------------ DATE---------------- -------------------------------------------- 1 Alterations and/or recommendations--------------------------------------------- --------------------------------------------------------- ------------------------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------- ------------------------------------------------------------------- - ------------------------------- ----------------------------------- ----------------------- «. �__ i �4 PERMIT No----3_�6----------- ISSUED------3_—/�---�------------(Date '�Com.- FINAL INSPECTION BY:----------- -,------�Z�"--------------- -------------- Date------------------- ��'f--------- ------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California '� 1=5-4-2M 9-5fl W-1b39