115 - Laserfiche WebLink

Home Browse Search

G APPLICATIONpFOR SANITATION PERMIT' (Complete in Duplicate) 49 Application is hereby made to the San Joaquin Local Health District- for a permit to construct and install the work herein described. 0 This application is made in�compliance with County Ordinance No. 549. -60e) � N L ctJ oo A-el . JOB ADDRESS AND LOCATION � '------ o titZ- S'`C-s_4-E_v__�c_o_o b-----`� �n��a�y_�,�,t? �7 we Owner's Name----- \- '°t S - ?--------- - l S?--------------------------------------------------------------------------- Phone-----t> -Z -------- Address---------------------------------------------w ------------------=----------------------------------------------- Contractor's Name--- ------- ' `, _-�-^.-.-__==---------------------. w-..-. ----------- - ,.---- -----'---- Phone--------------- - ---------------- E Installation will serve: Residence Apartment House ❑ Commercial.E] Trailer Court E] Motel E] Other ❑ - -r. , Number of living units: 'M Number of bedrooms I- Number of baths Lot size_- a__ --_-----X__- .- _ --__-= -_ Water Supply: Public system ❑ Community system ❑ Private Character of soil to a depth of 3 feet:- Sand Gravel Sand Loam Ga Loam Clay Adobe Hard an'[s� at p E ❑ ❑ Y ❑ Y ❑ Y ❑ I�r p TYPE OF INSTALLATION AND SPECIFICATIONS: 1Q , (No septic tank or cesspool permitted if public sewer is available within 200 feet.) . Septic Tank: 5 Distance from nearest well- V-----___Distance from foundation-_l-0- ---- Material_-C-4rq_C-_f3-:=-_-- 0� No. of compartments-_----_-- 1n........Liquid depth-4:---------- l Cesspool: Distance from nearest.well-------------------Distance from foundation--------------------Lining material----:-------_----------------_ - ❑ Size: Diameter----------------- ------•- _---------Depth--=--------------------------------------------------- Privy: ------------------------------- ----- Privy: Distance from nearest Well------------------------------------ ._-_i__:-----Distance from nearest building----------_------------------------------- El -_- __.---_---_---_---_----.❑ Distance to nearest lot line-----I---__!------------ ---_--___------_f ry Seepage Pit: Distance to nearest well-:S-5----------Distance from_tfaundation__�Q_--- -Distance to,nearest lot line__.'S__--_-_- Number of Its------- -------------Linin material._ _ � -lL-:size: Diameter=_-__- 0� P_ g 5--------------Depth-------------------------------- ,Disposal Field: Distance from nearest well--157Q------Distance from foundation---- tTZ__`._-.Distance to nearest lot line___-•_-_---_ [t�}� Number of lines___-__---k__________------------Length of h line___a_k-_----__ -.--Width of french----Z_4-- ---------------- Type of filter" materialS'Xt AAi s----_Depth of filter material-----A�1_'_`....... Remodeling and/or repairing (describe):------------ 0-------------------------------------------------------------------------------------•----------------------------------------------- ---------------------------------------------------------------=--------------------•---------------------------•---------------------------------------------•--------------------------------------------------------------- - ---------------------------------- I ------------------r--------------------------------------------------------------------'--------------------------------------------------------------------------------------."--------------•-•------------------------- I "+ f I hereby certify that I have'-pre pared this application and that the work will be done in accordance with San Joaquin County ordinances, State law and rulesrid regulations of the San Joocal Health District. . _-------(Signed) . d' - - ----------------------------------: ------------ ------(Owner and/or Contractor) By-------------------------- --_-----•-------------------------------*----------------•-------------••------•----------------------(Title)--------------------------------------------------------------- (Plot plans; showing size of lot, location of system ink relation to wells, buildings,%tc., must be filed with this application). a FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- --------------- DATE------ ;----� ©------------------- REVIEWED ------------ REVIEWED BY -- - ------ DATE----- "`.. BUILDING PERMIT ISSUED--------------------------------------------------------------------------------------------------- DATE.--------------------------------------------------•-------- Alterations and/or recommendations--------------------------------------------------------•-•--------------------------•----------------------------------------------•------ -------------••-----•----------=-------------------------------------------------------------------------------------------------------------------------•--------------------------•---------------------------------------- x i ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -'--------•---------------------------------•------------------- i ----------------------------------------------------------------------------------------------------------------.--------------v--------------------------------------------------------------------------------------------- PERMIT No.-VC{ i ISSUED (Date) FINAL' INSPECTION' BY:-------- -`� � Date-------------------------- ------------------------------ SAN ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT I 130 South American Street i Stockton, California ES-9-2M 9-50 W-1639