336 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. ' JOB ADDRESS AND LOCATION---- ' _-- ,r �"----- �'! "---------- ,-------- Owner's Name---=--•--------------------- - ---------------- -- -------- ----------------- Phone------------------------------------ Address--------------------y Contractor's Nama..._._ yam' = -•--------------- -----------------------------••---------- Phone---------------------------------- Installation will serve: Residence J�j Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: 0 Number of bedrooms 0., Number of baths ❑ Lot size___ --------_________________________ Water Supply: Public system ❑ Community system ❑ Private Al Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Z 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 hearest well__�07----Distance from foundation____ ----------Material-----_ tGiy!__-----____________-� 1] No. of compartments-------An--------------Capacity------------------------Size"3#_-= -- ----- depth---_Y-- ----_. Cesspool: Distance from nearest well-------------_---Distance from foundation--------------------Lining material__-________-______--__-______________ ❑ Size: Diameter--•-----------------------------------Depth---------------------------------------------------- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ El Distance to nearest lot line_______________________________________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest loft line______________ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Dept h--------------------------------- Disposal Field: Distance from nearest well AFar_r _ 01__ _-_.Distance from fo`ndation___ _ _______Distance to nearest fot line ._-_____ Number of lines------- of each l� e___.S�`at-1-O-Width offrench ---�_------------------------- Type of filter matenal_/14'"�----------Depth of filter material____________________ _ Remodelingand/or repairing (describe):--------------------------------------------------------------------------------------------------------------------------------------------------------- --------------- ..---------•---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sf fle laws, and rule regulations of the San Joaquin Local Health District. (Signed)----d- ----- ----- - ----- ---------------------------------------------------------------(Owner and/or Contractor) • Y• B -------------------- ----- Tale ------------------------------- (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---- -� ---------------------------- REVIEWEDBY-------------------------------------/ ---------------------------------------------------- - ------------------------ DATE BUILDING PERMIT ISSUED--------------------------------------------------------------- ---------------------------------•-- DATE Alterations and/or recommendations---------------------------- ----------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------•------------------------------ -----------------------------------------------....---------- ------------------------------------- -----------------------------------------------------------------------------------•-_-------------------------- -----------------------------------------------------------------------------.------------------------------ PERMIT No.__'2)')_(........... ISSUED----3-I_t _,.-5 ___________(Date) FINAL INSPECTION BY:---- UU Vx=-��------------- Date-------------------- --- _. �-. -�--------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W4639