19115 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: / --------------------------------- ------- ------------- APPLICATION FOR SANITATION PERMIT Permit No. /- ....... ------ -------- - ------- -------- " a _ (Complete in Duplicate) Date issued ----------- ------ ------- --,--- This Permit Ex ires 1 Year From Date Issued ------------ -- Application is hereby made to the San Joaquin Loca0 Health District for a permit to c struct and install the wort herein describe . pp e with County This application is made In com lianc9. � ------------------- P -- 306 VRE LOCAT N = ------ Owne ..�- - ------------ Addr Phone.44 Contr �` Motel ❑ Other Installation will serve: Residence Apartment House ❑ Co e tial'❑ Trailer C t ! w -- ------ ---------- Number of living units: _.ember of bedrooms --_-_--- Number of baths - ------ o size _-__-__--- - �,�m Table----._--- ft. Water Supply: Public system ❑ Community system ❑ . Private ' PP Y Clay ❑ obe ❑ Hardpan ❑ Character of soil to a depth of 3 fees: Sand ❑ Gravel ❑ Sandy Loam ❑ No Previous Applica+ian Made: (if yes,date_.----_--------- yNoNew Construction: Yes ❑ No FHA/VA: Yes ❑ _ TYPE F INSTALLATION AND SPECIFICATIONS: * !--- (No septic tank or cesspool permitted if p6blic sewer is available within 200 feet:)' 7 • 1 w. f. ` Se Distance from nearest w -- Distance from foundation_-------_--------.Materiaf------------------------------- of compartments- -' Size-------------------- ----- ---Liquid de tk---------------- -------- Capacity �, ------------------------ / } € -• _---,_-__-Distance to nearest lot line D SSI Distance from ne est wel �_.:--'Distance from foundation-- - Width of trench-"T�----- t i Number of fines___.- -- - -- - ngth of each line-- --- -e�� -` th of filter materi si Total length--------------------/ - ;� r 1��---- 1 C� Type of filter material- p , r seepage Pit- Distance to nearest well__'--.-.--- ----=- zistance:from foundation--------------------.Distance to nearest o ine-----.--_-._---. Distance -- Size: Diameter. ---------`;---------Depth-------------- ------------------ ❑ Number•of pits ------------------Liningkmaterl ----.------ Distance from nearest well----------------Distance from foundation-._.----------- �i n� Capacity ----gals. Cesspool: p ty-------------------- ❑ 'Size: Diameter--- ------------------------ Depth Distance from nearest building----------------------------- ------ Privy: Distance from i nearest well------------------ -- --.-------------------------- I ------------.--_-- -----.r ------------•- V - ------ - --------------------- - ❑ Distance to nearest lot ine-------------- ----- -- � -----------------------------Remodeling and/or repairing (descr - ----- _---_---.---___- -------------- ------- ---- ----------------- --- -- ---- -- - ---------- ---------- -------------- --------------------------------------------------------------- ---------------------------------------------------------------- ------------------ ---- ---------------------------- -------- + I hereby certify that av this on and that the work ill be done in accordance with San "Joaquin County k ordinances, State laCCws, ancj 7+les and regulati ns of th San Joaqu Local ealth District. !bard CT i IiShL --- ------------------ ----------------------------- mac - -- -- - �ontr for (Signed) .—.�� 9 )------- 5FP'T'iTitle F 2915E:MinerAye.r_�-kiQ6- ------------- -- -------------- --- -----( )------ --------------- gY (Plot plan, showing size of lot, location of syste I rela+pion f wells, uil gs, etc., can be place on reverse side). l I FOR DEPARTMENT USE ONLY -- -------------------- - ------ -------- -------- ------------ DAT --------- -w--�-��J---�----------- ------- - - APPLICATION ACCEPTED 13Y--.- �- - -� ----- ----- DATE------------------------------------------------------------ REVIEWED -------- ------------- ---------------------- --- REVIEWED BY------------------------- ----------- DA ------- ---- ---------------------------- ------ - BUILDING PERMIT ISSUED--------------:--- ------- -------------------•-----•--------- -------- ------ - Alterations and/or recommen a Ions--------------- - --------------------------------------------- ------ ----------------------------------- ----- ---------------------- - ------------------------------------------------------------- ------------------------- - - - - ------------------ &02- ----------------------------------- - --------- ---------------------- ---------------- ------- - •-------. - - . -- j - ---- Date--------- ./ -- ------ FINAL INSPECTION BY:- s SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Naselton Ave. 300 West Oak Street 124 sycamore Street 205 West 91h Street . Manteca,California Tracy,California Stockton,California Lodi,California v.P.co.