463 - Laserfiche WebLink

Home Browse Search

t APPLICATION FOR SANITATION PERMIT �� (Complete in Duplicate) Application is hereby mad comp)ance wi hquin Loyal Health District a permit to construct and install the work herein described. 49, ' I JOB ADDRESS ANDOCATON---ka`II_, 1--------* ------- ": '--------------------------------------------------------------------------------- ' � , "------------------.-.-.---------- ------=------------ Phone �,�u-a-�?-------- Owner's Name------------- Y '-------- '-� f! Address---------------�__._�- --f---•-- --- -----_ ----�---------------�-- --------------------- ----------------------- ------- ---------------------7----------------------- Contractor's Name-- ------- = ----- ------ Phone-- 1-- _ -------- I-nsfallation will serve: Residence �partmer ouse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ .------------------ Number of living units: Number of bedrooms,0 Number of baths [Z- Lot size------ R Water Supply: Public system Community system El Private ❑ Character of soil to a depth of 3 feet: Sand E] Gravel El Sandy Loam [j Clay Loam ❑ Clay ❑ A'dobe 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--------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-_____________-_.------___________-__. Size: Diameter-----------------=--------------------Depth------•--------------------------------------------- i Privy: Distance from nearest well________________________________________________Distance from nearest building_______----------_______________ . Distance to nearest lot line------------------------------------------------ / Seepa e Pit: .. Distance to nearest.well------_---- _Distance from foundation------7Distance to nearest lot line--_ Number of pits-------- ----------Lining material---j3_[?S__ Size: Diameter---34:,�___________.Depth------- � I F Disposal Field: Distance from nearest well------------------Distance from foundation--------------------Distance to nearest lot line__________-_---__ 4 ❑ Number of lines-----------------------------------Length of each line------------------------------Width of trench----------------------------------- Type of filter material_________________________Depth of filter material__________-____-----_- r l ` Remodeling and/or repairing (describe)-----------------�/a,"e"el----------- ---------`_9- ------------------ -- ��------------------------------ I _ ------------------------------ --- --------------------.--------------------------------------- --------------------- ------ ----- --------------- --- -- __________ ----------------------------------------------------------- ��r+ � __ ______!______________ ------ ______ _ __ • __________________________ _-________ --__-_____ ______ _____________________________________________________________________________________________________________________ _____________________________________._-----_-_---_______________ hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S a+e-la , and rules n regulations of the San Joaquin Local Health District. . d ----- By: ------------------------------------ -------------------------------.-(Q�!v�er and/or Contractor) f (Signe ) -------- 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 1 APPLICATION ACCEPTED BY------ --------------------- ----- -------------------------- --------------------- DATE-------------- .� _- -�-�j--- ---------- REVIEWED BY_---------r----------------- - ---=--------------- ONLY APPLICATION ---------------------------- DATE------------------------------------------ -------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------- Alterationsand/or recommendations--------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------- - 1 ------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------•-------------••------ ------------------------------- •--------------------------=}--------------------- ------------------------------•--------------------------------------------------------------------------------------------------------- PERMIT No.___ 43----- ISSUED'------------ 57----------(Date) FINAL INSPECTION BY:--------k--k)----11-- --------------------------- Date--------------------- --=------ 15--- -`-� i SAN JOAQUIN LOCAL HEALTH DISTRICT F 130 South American Street Stockton, California E5-9-2M 9-50 W=1639