Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
3 <br /> 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 /> JOB ADDRESS AND LOCATION----------------21-55------and---?_13-57-_W_al-e-r-14-0---Rd-'------•-•----------..__..------......--------------------------------- <br /> Owner's Name---A1---C_aye_114---------------------------------------------------------------------------------------------------------------------- Pho4 001--- <br /> Address---------------2 }12 - L3f aye te-_-T---Stk-'-n'-r------------------------------------------------------------------------------------------------------------------ <br /> Contractor's ---T_a.I'ik__a.eLr'Y-*-----------------------------------•------------------------------------ Phone----_3-------3--9 -------------- <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial (4 Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: f-I Number of bedrooms ❑ Number of baths 91 Lot size__5Q!___X---100---------------------------------- <br /> Water Supply: Public system [2 Community system ❑ Private ❑ <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [c 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 /> E6xistingNo. of compartments--------------------------Capacity-----------------------Size--------------------------------Liquid depth-------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- �N3 <br /> ElSize: Diameter--------------------------------------Depth---------------------------------------------------- `1' <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ <br /> El Distance to nearest lot line________________________________________________ <br /> Seepage Pit: Distance to nearest well---------------------Distance from foundation______-Ap.......Distance to nearest lot liner__��__r___ <br /> ® Number of pits----------],---------Lining material---hr_1k _ ff_ <br /> C ___ Size: Diameter_______ ___________?Depth-------_-as� <br /> _ __-?__nA.X <br /> Disposal Field: Distance from nearest well____________ <br /> p ,Distance from foundation-----1Q---------Distance to nearest lot line___ <br /> KI Number of lines------------1--------------------Length of each line________;P________?---.Width of trench_a1PP_'_' <br /> Type of filter materialTh'Vt'_d.;ADepth of filter material--------LP-11------ <br /> Remodeling and/or repairing (describe):---------- _epaJ x__ ng-------------------------------------------------------------------------- ------•------------------------ ---------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> I hereby certify that I 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 the San Joaquin Local Health District. <br /> (Signed)-------------------Delta__B-pp-ic,___Tank__Se __ _ (Owner and/or Contractor) <br /> - - - - --- ---------------------------------------- <br /> B -----------Parr- --Marthan- Title Owner-M <br /> By: (Title) <br /> lot plans, showing size of lot, location of system-i�.relati t wells, buildings, etc., must be filed with this application). <br /> Y . <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----------------- --------- DATE---- <br /> ------ ------------------- <br /> REVIEWED BY--------------------------------------•---- DATE------� s"-`--- <br /> BUILDING PERMIT ISSUED--------------------------------------------------------------•--------------------------------------- DATE <br /> - - ---------------------------- <br /> Alterations and/or recommendations-----------------------------------------------------------------------------------------------------------------------------------•---------------- ---------- <br /> •----------------- ---------------------------`---------------------------------------------------- -.. . <br /> -- <br /> ' =° �°3i:o�fri3 ,, ------------------------------------------------ --------------- - <br /> -------------1--�`--=�--- --�-b------{------ -------------------- <br /> PERMIT No.__3�!------------- ISSUED___.2__ls _ '____________(Date) FINAL INSPECTION BY:_ <br /> Date-------------- -tT-� <br /> ----•---------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-2M 9-50 W4639 <br />