22461 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: �- ---- ----------- Permit No. .�.r�...� '------------------------------------------ --------------- - APPLICATION FOR SANITATION PERMIT --------------- ---- --_.___ __-__.______--_ (Complete in Duplicate) Date Issued /9-:-9-2�/' ----------------------------------- -------_- This Permit Expires I Year From Date Issued ------ -------- ------ - ---- 1 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 inbcompliance with County Ordinance No. 549. . ; p.:? JOB ADDRESS AND LOCATION___.___ .T �wc�cJ�a 'O Phone........... Owner s.il, ------ : -----PFJ_SDN'---- ------------- ------------3------- Address_...::': -------- --•-- -•---•----I-•-------- phone------- -------------- ---- Contractors Name__.___-- � --- Motel ❑ Other ❑ Installation will serve: Residence pa Apartment House ❑ Commercial ❑ Trailer Court ❑ I 9 f__. Number of bedrooms _. Number of baths _A.. Lot size .___---�-----------/0 vev-•• Number of liven units: __ ._ --- Water Supply: Public system ❑ Community system A Private ❑ Depth To Water Table/ -- ft. 'I Character of soil to a depth of 3 feet: Sand" Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: {If yes,date----------------- I No [X New Construction: Yes K No ❑ FHA/VA: Yes ❑ No ❑ 1 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if publ`i'cewer is available within 200 fee ` Septic Tank: Distance from nearest well____-.-____ Distance from foundation----1 __________Matenal._____..__�-----•.-- �� No. of compartments----------<----,---- -- Size---u�?'_d►__X_1----Liquid depth--•-_--s-------------Capacity.-1 . Disposal Field: Distance from nearest well4iVV..-Distance from foundation------`-P..--•.Distance to neares�tline...p Number of lines----•-•--�-----------n------- -Length of each line---._---�--�-�----��-----Width of trench___-.- -••----•---•--------•---... Type of filter material._.t/:.i_/�-O! -Depth of filter material____. Q-___.....Total length------- �'� -------------------- Type Pit: Distance to nearest well----------------------Distance from foundation___________________.Distance to nearest lot line__--___-.___.___- Number of pits----------------------Lining material----------- ----------.Size: Diameter_---------------------•Depth--------------------------------- 0 ------- •------------ [! ❑ Lining material -------------- ------------- Cesspool: Distance from nearest well_________________Distance from foundation-------------------- Liquid CaPacitgals. ❑ Size: Diameter--------------------------------------De th-------------- ------------------------------------- Privy: ----------------------------------privy; Dis#once from nearest well __-__________-------------------------- -------Distance from nearest building-------••--------•-----••---------------- ❑ ; Distance to nearest lot line---------------------------------------------- - ------------------•----------------------- Remodeling and/or repairing (describe):----------------------------------------------.____._ --------- -- --------- --- -------•----•-----------••----•-------•-------------------------------------------------•-----------------------••--------------------------------------------------------- ! herebycertify tl ws have application the San Joaquin hLocalkHenitheDistr done in accordance with San Joaquin County ordinances, 5 , ) ontractor Signed - ------ � '----------------------------------------------- - Owner and/or C -------- - ------ -------------------------------------------------------------(Te)eti ------ By--------------- ` (Plot plan, showing size of lot, location of syste in relation to wells, buildings, etc., can be placed an reverse side). FOR DEPARTMENT USE ONLY _ f1 - -r--� O I3 = DATE------- --- ------r-------._..._ APPLICATION ACCEPTED BY_._.-___ _�_- -_ _-_-_----------- -------------•---------- --- DATE---------------------------------------------------------- BUILDING BY--------•----------------------• - ---------------- -- -------------------------------------------- -----------------------------------------------------------•---- DXTE--•--------------------------------------------------------- BUILDING PERMIT 155UED----------•-----------•---------•- -• --•----------•---�-----------•--•------• --•----------•- Alterations and/or recommendations:---------------------_ -------------------- --------------- ------------------------------:----------------------------------------------------------------------------------------------------------------------------_--:-:--:---�---�---)-�----------------------------------------------------------------- ---- ------------- --------------•-------•--•---------•...- - --- -- ----------------------------------------------------1-----.-.-.-.-..-.-.-.. -.--.--.- ..- - ---------------- 0 r� FINAL INSPE�C-T4Q. 1�B•Y:_ - sZ Q------- - -- - Date--------- -----•--<0.-"'.•-��.-�- -- -e^--- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 124 Sycamore Street 205 West 91h Street 130 South American Street 300 California Stockton,California Lodi,California Manteca,California £5 9 REVISED 5-59 2M 5-62 ATLAS . w�