291 - 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. JOBADDRESS AND LOCATION------:?-__--!-5------ �l'�l,.A-J----------------------------------------------------------------------------------------------- Owner's Name------- ---------------------- Phone------------------------------------ V wJ Address-----------------r �-------------------------------------------------------------------------------------------------------------------------------------------------- Contractor's Name-------------------------------------------------------------- Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ W g ® [ © = Q is ----------------- 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 ❑ r TYPE OF INSTALLATION AND SPECIFICATIONS: Septic Tank: Distance from nearest well___________._-__Distance from .foundation_____________' -------------------------------- (No septic tank or cesspool permitted if public sewer is available within 200 feet.) p _____--Material--------- ---- ❑ No. of compartments--------------------------Capacity-----------------------Size--------------------------------Liquid depth-------------------------- - Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material______________:____---_____________- ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------- .,privy- -------------•------ -----------------------------.,Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-------------------------_--------------- ❑ Distance to nearest lot line------------------------------•----------------- .Seepage Pit: Distance fo 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 'f lines-------------•--------------------Length of each line--------------------- .Width of trench----------------------------------- Typb of filter material--------_----------------Depth of filter material ---________---------- '-Remodeling and/or repairing (describe)-------------------- --------------- -------------------------------------------------------------------- ''/r --------------------------- / / �{ � / --------- -- �o I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stalaws, and ru s a regulations of the San Joaquin Local Health District. K ``// (Owner and/or Contractor) {Signed)_h-. -------- ----- By:---------------------------- ---------------------V------------------------ -----------------------------------------------(Title)---------------------------------------------------------------- (Plot --------------------------------------------(Title)---------------------------------------------------------------- (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------------------------6,,f_; DATE---------�f ----- REVIEWED BY------------------------------------------ - -- - - - DATE-------------- ----------------------------- ` BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE-------------------------------------- -------------•------ Alterations and/or recommendations:-------------- ----- -------------------------------------------------------•---------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------- ------•-------------------------------------------I------------------------•------------------------------------------------- ------ -------------•------ ------------------------------------------------------------------------------_---------------------------------------- -------------------------------------------------------------------------- PERMIT No. s}Ql ISSUED_ ��' S ------------•-•-(Date) FINAL INSPECTION BY:-- --------------------------------------------------- Date _ `/.6/y_.f1-- --------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9--2M 9-50 W=1639 + l - ��