SU0011426 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Applicafion is hereby made to the San Joaquin Local li alth District for a per to construct an nstall e work herein described. This application is made in compliance it�CJoun�Ordinance No. 549. N JOB ADDRESS AND LOCATIO ------ .WO.,-':..-./441 -...- ..........................................-.......... Owner's Name-------.-,7x........ -------------------------------------------------------- Phone..................-.--------- Address----_----------------------------_--------_----_------------..............-•----...._.......-...-----•--•—--------------------------------------------------------------------------•---- Contractor's Name......... . ire'.................-....................................._.........-......------........... Phone..--- -------__-----.-•------ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑/� 9 rf- Number of living units: [I Number of bedrooms Qf Number of baths V Lot size....-'�-+'s,S -`� -- CC-------X-41 I Water Supply: Public system ❑ Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑, c 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.....f'..� Distance from foundation....... ........Material........ !_---r�--_-__._..r-.-(/......... No. of compartments...........-'_''..--.Capacity..._ -----Size----� ' X...?_.Liquid depth..1.4/... ............. Cesspool: Distance from nearest well-------- ------Distance from foundation................._.Lining material....................._...._.......... ❑ Size: Diameter..__ ---------.Depth_..........._._.------•----•-------------_.-. Privy: Distance from nearest well......................._._....._.. .. .i ------_-._..Distance from nearest building. ........:...........---------------- . ❑ Distance to nearest lot line.........____-------------_..------- Seepage Pit: Distance to nearest well......................Distance from foundation.- ._....Distance to nearest lot line..._..... ....._. ❑ Number of pits......................Lining material---------------- -Size: Diameter-----------------------Depth -----'----a 41 J. Dispo al Field: Distance from nearest well----- _....Distance from foundation.._C.!T......_...Distance to nearest lot line- .__4..._ Number of lines....._..........A..... �� angth of each line...._...._,.r4--.--_._ .. Width of trench--- Type of filter materiel..._Imo_�-+ItJSR uepth of filter material.__......_�O_�___ Remodeling and/or repairing (describe):..... A- .... --------• ------ - -------------------------------- -- -- - -- ------- ----------------------------•------------------......------...----------- -------------...................................----------------------..................-..........-..................... 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 the San Joaquin Local Health District. ----- b -------- - 40wner and/or Confrac+or d (Signe .____<, owing (Title)... (Plot plans size of lot, location of system in relation to wells, buildings, eta, must be filed with this application). FOR DEPARTMENT USE ONLY101 '1 111 4 / APPLICATION ACCEPTED BY .. i/ --------------------------------............................ DATE------... --------- ((// ............ DATE.......... - -- --•----•--------- REVIEWEDBY_-------•------------------------------------------•----------•-------------......------ BUILDINGPERMIT ISSUED----------------------- -----........-----------........................................_ DATE.- _._....---------------------------m------------ Alterations and/or recommendations:........-..........---...................................................--.................. _ .... -- --------.............. _ ._......_.....__...................................-.........__........................... ..............._..................................._.__.... .._._...........---......._....................._...........-............................. -- ---------------- PERMIT No.... - -------- ISSUED.... .... -----(Date) FINAL INSPECTION BY:..._......w.../.Y...-. -._-------------------- Date.......-------- �.................... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California oc_o_7u G.Sn W-1639 \