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 described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> f � � <br /> / _ e-------------------------- ---- <br /> JOB ADDRESS AND LOCATION---------•----------�---------------- ---------------------------------------------------- ------- <br /> Owner's Name-.---------- �,_---�ur ePs---n---------- ---------------- Phone__j� ----------- <br /> Address------••-----------------------y �+_--- � Q------kf%F----------------------------------------------------- <br /> 14L��!_� �p--G�----------------- - -- Phone------------- <br /> Installation <br /> ------ -- <br /> Contractor's Name.-X-1. ." - ---`-�'-��'�-�-r-- -- ---""----"-••--- <br /> Installation will serve: Residence [X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number.of living units: 14 Number of bedrooms 0KNumber of baths [� Lot-,size-------I&*x---I-Y"p-f----""------------- <br /> Water Supply?` Public system 0 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-------------------.Material___.-_____---__-_----_--_--__----_--__---_----_ <br /> 0 No. of compartments----------- --------------Capacity-----------------------Size-- ------•Liquid depth------------------------ <br /> Distance from nearest well---------_-------_Distance from foundation--------------------Lining material-_------------------------------------------ <br /> ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------- <br /> Privy: <br /> ----------------- ----------------------------- <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_----------_-__-----_--_----___--------_-. <br /> ❑ Distance to nearest lot line-------------------------'-------------------- / <br /> Seepage Pit: Distance to nearest we� 0Uistanc from foundation---2""--_--------Distance to nearest lot line-S-__------- <br /> ( Number of its <br /> __1--------- mate <br /> Size: Diameter Depth s j <br /> 4 --- Y <br /> p : o <br /> Disposal Field: Distance from nearest well_� Q�--Distance from foundation---�d_-�""."".Distance to nearest lot line"__ .-_-"_"""_ <br /> Number of linesl------------- - ""-.""Length of each line_--,�la'___- �---Width of trench---- - ------------------ <br /> lie, Type of filter material.._/__3-"_ ___"Depth of filter material-_--_- -" "_----:--- <br /> Remodeling and/oriepairig (deser�be :-_""______ ""�" " �'4'� 1� a�-------- <br /> I �''"'`"" <br /> f 4 <br /> ---------•------- -------- ---- <br /> ' -------ant- "- ------------- <br /> --------------•---------------------------•-----"------------------------•----------- <br /> ------- ---------------------•------------------------ <br /> E -------------------------- <br /> - ------ ------------------------------------------------------------------------------------------------------------------- <br /> I hereby certify that l have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of an Joaquin Local Health District. <br /> 1 M1 ��5 I!C ------------------------------------(�Contractor) <br /> (Signed)-----�- - -`----- -��-_s`� � <br /> ' - ---------------- - ----------------- ------------------------- Ti+le - fQ -------- ----------- <br /> (Plot ans, owing size of lot, location of system in relati +o wells, buildings, etc., must be filed with this application). <br /> 1 FOR DEPARTMENT USE ONLY <br /> 'fAPPLICATION ACCEPTED BY------------------------------------------------- <br /> --------------------- <br /> ------------------- DATE ~ �' —`� <br /> REVIEWEDBY.-----------•---------------•---------------------------------------------C;4------------------------ ---- DATE------------------- ---------------- <br /> BUILDINGPERMIT ISSUED-------•------------------------------- ------------------------------- DATE-------------------------------------------------------••_-- <br /> Alterationsand/or recommendations:--------------------------------------- ---------------------------=---------------------•----------------------------------------------------•----------- <br /> ----------------=-------------------•--------------------------------------------------------------- <br /> --------------------------------------------------------------------------------------------------------------------------- <br /> --------•-----•-----------•----------------------------------------------------------- <br /> i ------••------------------------------------------------------ <br /> ---------------------------------------------------- ----------------------------------------------------------------------------------- <br /> PERMIT No. ISSUED-.-� a-'� ----------------[Date) FINAL INSPECTION BY:---------�- -�----•-•------------------------- <br /> Date--------------------- ---�-�� -------------------- -------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> k ES-9-2M 9-50 W-1639 <br />