22007 - Laserfiche WebLink

Home Browse Search

O OFFICE USE: �d�7 ------------------------"------------ APPLICATION FOR SANITATION PERMIT Permit No. ....... .... ... --------- ------- --------- ------------- ------------- (Complete in Duplicate) Date issued _ _.- � This Permit Ex ires 1 Year From Date Issued the work herein described. Y Application is hereby made to the San Joaquin notal Health District for o a permit to construct and install This applicat+on is made in compliance with County r ----------------•---- I JOB ADDRESS AND LOCATION-- Phone------------------------------------ Owner's Owner s Name _1K-l��yy�y" . _ ------ .I• �f'«•._ ' ----------------" `------------------ Address - '-------•- - -- - - " Pone_. " Con#ractor's Name-------- - �---� "� --" Other - Trailer Cour} ❑ Motel ❑ ❑ 1 Installation will serve: Residence Apartment House ❑ Commercial ❑ �� XX"--Number of living units: _- - Number of bedrooms.--- Number of baths _ "-__ Lot size ® ®0 i Private Depth to Water Table I_ft. Water Supply: Public system ❑ Community syste� ❑ Adobe Hardpan ❑ Character of soil +o a depth of 3 feet: Sand ❑ Gr 1, ❑ Sandy Loam ❑ Gay Loam ❑ Clay ❑ I Ch r No FHA/VA: Yes ❑ No �. Previous Application Made: (If yes,date..__-----'i---•-----�� No �N ew Construction: Yes ❑ �� TYPE OF INSTALLATION AND SPECIFICATIONS: ( (No septic tank or cesspool permitted if public sewer is available within 200 fee+.} Septic Tank- Distance from nearest well_-"______________'Size--nce from foundation------------------- Septic depth--Materia-----.---_Capacity---.".._-_-_ -.-_-__ � '/i� f No. of compartments- Size q P � Distance to nearest lot line_ DIS asal Field! Distance from nearest well..._----Distafln .fres foundation_ - Width of trench- _- -------- ------------ / "----__ en th of each line_. �'�--- 4 Number of lines �f g Total length ./a?�---- /' De th of,filter matenal--_-� -------- Type of filter materialX.-It �� P / ,�-• "_Di tang to dearest lot line-2,0P :'fro fou ation� --- � � Seepage Pit: Distance to nearest well.._�Q ----- t Number of pits_-- --------------Lining.mater al_. -- -- ----Size: Diameter. Depth.. �� ��fCAsp/1,I CesDistance from nearest well--_--"_--_______=Dei{ince from foundation----- ______---------- _______Liquid Capacity_... -------------- --•-gals. � k, ❑ Size: Diameter. - 1. Privy: Distance from nearest well__ ------ ------ 3 ---"-t-----.._Distance from nearest building 1 -- �-- -- - �' -----•---------------- --- Distance to nearest of ine.-_...{-_.____--- r ` - --------"------- odelin and/or repairing (describe):_..-____. - -/ ,e 4 ------•------------------ fi ----------------- ------- --- ------------------------------- I hereby certify that I have paeparegulationsdthis ole wor f theon and +hat San Joaquin Local kHealth eDi}rsctn accordance with San Joaquin County ordinances, State laws, and rules --{� Contractor) ........................... ---- ------- -- (Signed)• irf By:-----------------------•-------------------- --------------------- W plan, showing size of lot, location of system ' relati +o wells, buildings, etc., can be placed on reverse si e. FOR DEPARTMENT USE ONLY ----- ---------------------- APPLICATION ACCEPTED BY --- -------------------- ----""- --------- ----------------�- DAT -------------- --------------------------------------- REVIEWED ------•------------------- --------•------ -- -------------------------------------------------------------- - - REVIEWED BY- DATE BUILDINGPERMIT ISSUED----------------------------------------------------------- - ----------------------------------•---------------------------- - ---------------------------- --------------------------------------- Alterations and/or recommend_+ions:____._--------------- - -------------- ------------------------------------".__-- b^ b"i FINAL INSPECTION BY:- -- -- ----------------------------- Date----- ------ ----�-- -�- ---- -�----�-- �- --�- -------- - SAN JOAQUIN LOCAL HEALTH DISTRICT HaseHon Ave. 300 West Oak greet 124 sycamore Street 205 West 9th Street 1601 E. Stockton,California Lodi,California F.P.CO.