22050 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE-. .y �7 !1>-'-3o Permit No. "�� --- -- APPLICATION FOR``SANITATION PERMIT ----------- ---- -------- ---�0_ -------_- (Complete in Duplicate) Date Issued Z7// -------- - -- -- - --- ----_ ." - This Permit Ex fres 1 Year From Date Issued made to the San Joaquin Local Health District for a permit to construct and insta�i ��rk h�eln..,�escr Application is hereby .- - � .�-d This application is made in compliance with Cony Ordinance No. 549. /Da2/v S ----- ------ ---------- - JOB ADDRESS AN CATION--r-------------- -- Phone77 ---- Owner's Name----- s •-----•----- 1 -- ---- Contractor's -- ,7- Address----------------- -• -- --------- __ -- -- --- --•----------••-• � ____ ------------------------------------------ Phone -- --•- •- - - ❑ Motel •. Installation w+11 serve: R idence Apartment House ❑ Commercial Trailer Court ❑ . Other;❑ ` Contractors Name._____"._ - - -- - - - ,, v I ell— t Number of living units: "_r!- Number of bedrooms " Number of baths -/----- Lo ► Water Supply: Public system F1Community system [IPrivate Depth to Water Table�Pft Character of soil to a depth of 3 feet' Sand [I Gravel ❑ Sandy Loam ❑ Clay Loam El Clay ❑ Adabe� Hardpan C] FHA/VA.. Yes El N Previous Application Made: (if yes,date---- --_-------. " ) Nog— TYPE ' >New Construction: Yes El j9- o k TYPE OF INSTALLATION AND SPECIFICATIONS: { No septic tank or cesspool permitted if publicseweris available within 200 feet.) t Capacity Septic Tank: Distance from nearest welL.7S""------Distance from foundation" Q---- Materia compartments--------- ---------------Size------`----- -- ---------- Liquid depth P Y r of r .------__.Distance to nearest lot ]in e.----•-- Dis Disposal Field: Distance f om nearest welll�S------Distance from foundation rj p Number of lines - _-- -- ./.__ ------Length of each line9_�-- +--__..Width of trench__ --------- r De th of filter, material__- ._ _-----------Total length--------- --Q Type of filter material p I " f a�______Distance to nearest lot line_40------- Ly .. t .K Seepage Pit:" Distance to nearest well _Distance f m f n ation- _____-.___ 4 r Number of pits_= Lining matersal_� ��Siz Diameter.( Depth ng material Cesspool: Distance'from nearest well -------------- Distance from foundation:-. -- -Liquid Capacity....__--_._.,_-._____-------gals. f ❑ Size: Diameter- -- -------- - --- - ----- Depths'__: '---- - - ---Distance from nearest building----------------------------------- - Distance from nearest well_____.......................................... Privy: . --- f ❑ Distance to nearest lot line ----.------------------- ----------------------•------------------ Remodeling and/or repairing (descrsbej:__ - -- -- ------------- F¢ ---------------------------------------- - -------------- 5 ______________________'_____.__.____-_. - - --------- _ _ _ __ _______________________________---________-_____.____-_______.-___________.______--_______--_._"____-.______._.___________________...__-__...____.--------------- ----------------------------------- _ _- _ - ---"-- I hereby certify that liilav prepared this app ation and that the. rk will be done in accordance with San Joaquin County i ordinances, State laws, a d r s[and regulptions f the San Joaquin kcal Health District. _q"--- er r Contract - - ------ ------ - -- Title (Signed) �, ----- F i p l� lay• g #ation of system in relati n to wells, buildings, etc., can be plat on reverse side). (Plot Ian, showing size of lot, to y f FOR DEPARTMENT USE ONLY / ��c/ DATE------ - - Z- -------- ---------------- APPLICATION ACCEPTED BY-- --------- ---- - ---- - -------------------- - t -------- --- DATE------------- ---------•------------•---------------- -- - REVIEWED 8Y- - - - DATE •------- BUILDING PERMIT ISSUED----------- -------- t ----------------------------------------------------------------- - -- - - ------ Alteration --- --------- Alterations and/or recommendations:...... .......... ..F`r--�G- _ " ----------------- - ----------- ------- --------- -------- ----•-- --- --- - --------- ------- /J,,,�/ Date----- ---- 7�� ------------------ FINAL INSPECTION BY:..__. +--- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 124 Sycamore Street 205 West 9th Street 1601 E.Hq:olton Ave. 300 California Stockton,California Lodi,California Manteca,California Y. E.H.9 2M 1-67 Vanguard Press