437 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT 3 7 (Complete in Duplicate) Application is hereby made to the San Joaquin Local Heaith District for a permit to construct and install the work herein described. This application is made in compliance with County Ordin�nc/e��No. 549. P,Q04 RESS AND LO�A}T14 � � �'� ---(J�f� 40 l �'`. ( • ------------------------------ r s Name " �tg�/C __ ---------------- - - :--:---- ----------- --------------------------------------------- Phone--- - ---------- -- Contractor's Name------------- �N.� ,D/ -- ----------------------------------------- ---------------- •------ -------------�,/ ��/ e'i . r------ ---------------- Phone---------------------•------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial n Trailer Court ❑ Motel ❑ Other ❑ Number of living units- ,❑ Number of bedrooms ❑ Number of baths ❑ Lot size________________________ 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 ❑ 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_________________Distance from foundation_______._____-____-.Material _________-____________________,- -------------- ❑ No. of compartments- Capacity-------------- -------Size--------------------------------Liquid depth----- -- ----------------------- Cesspo l: Distance from nearest well____ ________Distance fro foundation-----------,_____ m Lining aterial___41 c a I Size: Diameter--- .�� )C -----`/-----Depth-------- Priv � Y- Distance from nearest well-------------------------------------------------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---------_----- ------------------ Disposal Field: Distance from nearest well_______________ Distance from foundation--------------------Distance to nearest lot line------ Number of lines-----------------------------------Length of each line------------------------------Width of trench ------ Type of filter material_________________ Depth of filter material----------------------- Remodeling and/or repairing (describe):___-__________________ ------------;-------------------------------------------------I-------------•------•------------------------------------------------------- ---------- - ------- ---------------------------I------------------- -------------------------- - # =----------------- er --certify ---- that -- --av - ----•------------------------------------------------------------------------------------------------------------------------------------ I hereby certify }hat I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State I� d rules and r ulations of�he San Joaquin Local Health District. r, (Signed)- ------------------/ -----------------------(Owner and/or Contractor By--------------------------------- ------- Title ) (Plot plans, showing size of lot, location'of system in relation to wells, buildings, etc., must be filed with this application). ------ I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY___-________�!,-1__ ,/.] ___ CSL! j ------------- ------=---------------------- DATE----- ------------- REVIEWED BY------------------------------------- •� ----- -- --------- ----------- �-�- ------ DATE-------- - ---------- ------ - .- BUILDING PERMIT ISSUED------------------------------------- ------------ DATE ------- - Alterations and/or recommendations:___�_____________ _ ------------------------------------------- --- -------------------- ----•- ------------------------------------ -------------- ----- -- -- PERMIT No//-j--7 .3 __-- -- ISSUED------- ,t-_77/------- FINAL INSPECTION BY:--------- ----------------------/-------•----------------- Date 6- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ES-9-2M 9-50 W=1639 Stockton, California