1058 - Laserfiche WebLink

Home Browse Search

k o • � d "F APPLICATION FOR SANITATION' PERMIT Q (Complete in 'Duplicate) I Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This applicationhis.made in compliance with County Ordinance No. 549. JOB ADDRESS D LOCATION----------5Z3---S-- Garden Owner's Name_ --- �a--�-��- 0-S.r_t£r--------------------------------- ------------------------------------------ Phone----:47n9393--------------- AddressSame ------------------------------------------------------------------------------------------------------------------------------------------ .�� Contractors Name---------------1?k:�.ta----------- --- ----- -- ------------------- --------- ,- ----------------------------------- Phone------3-39'55- ---------- Installation will server Residence [2p Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [❑ s Number of living units: ] Number of bedrooms a Number of baths Ej Lot size-------_9OxJ,25____________________________--______ 1 I Water Supply: Public system ® Community system ❑ Private ❑ r Character of soil to a depth of 3 feet: Sand Gravel Sand Loam Clay Loam Clay Adobe Hardpan P ❑ ❑ Y ❑ Y ❑ Y❑ C� P ❑ U�. TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) W 1 ''Septic Tank: Distance from nearest well_______________Distance from foundation-------------------.Material _____________________-._______________________. 1EXTSUNG No. of campartments�_________________ -_- -Ca acitY-----------------------Size--------------------------------Liquid depth----------------------- --- � Cesspool: Distance from nearest well_______'________Distance from foundation---------------------Lining material_______________________- - ❑ Size: Diameter---------- ---------------------------Deth---------------------------------- p - -- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-------.______-____._____________________- '., ❑ Distanee to nearest lot line------------------------------------------------ Seepage-Pit- ----------------------------------------------- See a e Pit; Distance to nearest well-_._______"'__ 10� 1 p g Distance from foundation-_ to nearest lot ling_-____5_______ EX • i Number of pits------I------`------Lining materEal___�X'�0.�---Size: Diameter------------------------Dept h_____25,_____-____________ 'Disposal Field: Distance from nearest well_________________Distance from foundation__-__.__.-____._..Distance to nearest lot line_____-- --_____ EXIT�� Number of lines-----------------------------------Length of each line--------------•---------------Width of trench---------------------------------- ,� Type of filter material-------------------------.Depth of filter material----------------- Re _______-_______._____ Remodeling and/or repairing (describe):------I S-tB- 1J'.11. __ ,elt_--Ve�'t�e_��_dr!I 4ZI1__u,-xlCi__!QQXInE;_ un !0 t-'_?ca---e -?-StAL^0---ue�t10---t -k— xJ,t-2 s�1i�---1�---app-�----1 d----------------------------- ----------------------------=----------------------------pr- ------------------------------------------------------------------------------------------------------------------------------------------------------------------ - - -------------------------------------- ------ -- ------.------------------------------------------------------------------------------------------------------------............................................ hereby certify that I have epared this application and +hat 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) -Delta = ------ -----W ------------------------------------------------------ (Owner and/or Contractor) BY:------------------------Pew y yY�-than-- -- --•-a_ --------------(Title)------Q�,r-4er.r.TM r--------------------- ------- (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this"application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------- --- ------V---- '---- ------------ --------------------------- DATE----------- -- -- -- ------� YREVIEWED BY ---------------------' ti 1 DATE -- -------------------------------------- - ------- ------------- ------ BUILDING PERMIT ISSUED -------------------------------- --------------- DATE Alterations and/or recommendations:_-------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------- ------------ ------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------ ---------------------------------------- ------------:-- ------------------------------------------------------------------------------------- ------------------------------------------ ------------------------- -- l J 1 ' ' PERMIT . �� ._ ISSUED_____________ __/-��_-(Date) FINAL INSPECTION BY:_________�!v_ V_-��_ _ - ---------- ------ - ----------------------------- Date----------------------r'a `3 w SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street I Stockton, California ES-9-2M 9-50 W=1639