1026 - Laserfiche WebLink

Home Browse Search

' F APPLICATION FOR SANITATION PERMIT r la (Complete in Duplicate) Application is hereby made to the San Joaquin Local Health District f4 a permit to construct and install the work herein described. This application is made in compliance with County Or e NoJ54 JOB ADDRESS AND LOCATION-_ -------- / r Owner's Name- -- � � y Phone- -_ one -------------------- Address------ ------------------------------------- ---------9�;Jr1---- 191 -- aw__e--------------------------------------------- Phone- Re ------- Contractor's Name----------- _ f Phone__ _O7 Installation will serve: Resident J4 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms �p r -- Number of baths [I dot size----_______________x__ Wafer Supply: Public system p Community system ❑ Private 9- Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe . Hardpan ❑ � TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tank or cesspool permitted if public sewer is'available within 200 feet.) i Septic Tank: Distance from nearest well_�0_------Distance fr m foundation_��-� atL�l - ----� . . •. No. of compartments______�Y- --------Capacity. do- -Size_4yZU_�[-/3-- --Liquid depth__- -".------ Cesspool: Distance from nearest well ______ Distance from foundation____________________Lining material------------------------------------- ---------- Size: Diameter Depth--------------------------------------------------- Privy: ---------------- sta - - ----------------------------------------- Privy; Distance from nearest welt__________________________ __ _______Distance from nearest building - ------------ - Distance to nearest lot line-_----____-,---_•_ - - r Seepage Pit: Distance to nearest welLjQQ�______D' nce fr ou ion__-_ �"" Distant to nearest lot line____________-__- Number of pits--------�__--_---__Lining ma erial______ Siz iameter----45_�--_--------Depth_-cgwP ------------ ------ .Disposal Field: Distance from nearest well----6Q�__Di nce fro ation- O� �__-----------Distance to nearest lot line_____�_�_ q 1K Number of lines______________- Length of each line___-Q--' `. Width of trench-----a ,_----_------- Type of filter material___! - --Depth of filter material___�� r�___-- E Remodeling and/or repairing (describe)-------- ---------------------------------------------------------- _______ _ QG� CJ.fJr_a-107------- ----- - ------- --------- --------------------------------- ------------------------------------------------ --- ------ - ------------------------------------------ --ere -- - r - ------------------------------------------------------------------•-------------------- ------------------------ ! hereby certify that ave prepared this application and that the work will be done in accordance with San Joaquin County ordinancesXSfa I nd les and' 'regul of the San Joaquin Local Health District. ----- '• Vvi ------ Contractor) BY: le. --- ---------- (Ti )IEa of plans, sh mg si n of system in rela+i to wells, buildings, etc., must be filed with this application). /y( FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED DATE REVIEWED BY-------- ----------- ------------ ------ -� - ------- --------- --------- -�-------- ---�------ --------- ------ DATE----DATE--1/71. PERMIT ISSUED -------------•---------------------- ----------------- -------------- DATE----------------- /------- -- --- --------------- ------------------- terations and/or recommendations:_ :_ .__ - - ----------------- ----------- ---------------------------------------- ------------------------- -------------------------------------- --------------------- „ - ----------------------------------------- - --- --- / - - ----- - ----------------------------------------- -- --- PERMIT No./P__)7_4----- ISSUED------------ --- I r� S-y�--------(Date) FINAL INSPECTION BY:-------------W-- i Date I SAN JOAQUIN LOCAL HEALTH DISTRICT { 130 South American Street ES-9-2M 9-50 W=4639 Stockton, California