1 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT , (Complete in Duplicate) ��pplication is hereby made to the San to construct and install the work herein described. n Joaquin Local Health District for a permit �rhis application is made in compliance with County Ordinance No. 549. 1�! X4-2 SAl _ S - ----------s P° �_To !+J ------ JOB ADDRESS AND LOCATION___.:____.-"__-•- " ------ I --- Pone-----------_41-7-1-7---- 15 ISI"f?-_!_Q S 5---------------------------------- --- e�� o Owner's Name-----------'- ----- - -- 1`Y42 S _------------- Address 5- T--------------�----- --------------------------------•------------------- S~ 3-. * phone -------•-------------------------- Ad d ress-------------------- Contractor`s Name ------------ •------------- - Motel ❑ Other ❑ Instaflation will serve: Residence )�[ Apartment House ❑ Commercial ❑ Trailer .Court ❑ Number of bedrooms CE Number of baths ® Lot size -------- X Number of living uni#s: '[� Water Supply: Public system L{ ommunity system El Preanam ❑ Clay Loam ❑ Clay Adobe Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Y r TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within Z00 feet-).Lo.IC ----- /,, C�_ _.__Size" y� q x ,S OD Liquid depth -------- --------------- , $ #ic , ank: Distance from nearest well__ :`-----Distance from found ----------- _d__ �Q No. of compartments___________ --------- Capacity --.-" from nearest well_________________ Distance from foundation___-______--- Lining material_-_____-. ------------ Cesspool: - ----- 4 1711 Size: Diameter --------------------------------------Depth___------------- ' -------------- - Distance from nearest well ------ ------------------------------ ------ Distance from nearest building"'___ ------- Privy: _ _ _ ❑ Distance to nearest lot line-------------------------------"---- - " - Distance to nearest well ---------------------- Distaanl e from founds ae npiame#er---_Distance tonearestlot line--.-__------- Seepage Pit: Linin mate ,6 ',Q ❑ Nvmber of pits ---------------•---- g �� •6 ^o__" -_.Distance to nearest lot ine_________________ L/4 7___. k fJ � �'is os�'Field: Distance from nearest well_____ _____�¢"`-.Distance from foundation-----_______ Number of lines.------.--•--- ��^'11 -----Length of each line -------------------- ---------- Number - Width of trench --------az- .e �- De th of filter material_____tA _------- Type of filter material_____7�--- p Remodeling and/or repairing (describe -------------- -------- -- ------------ ------------------ ---------------•----------------------•---------------------------------- ------------------------------ --------------------------------------------------------------------- --------------------------------------------------------------- done I herebycertify that I have prepared this application San i that Joaquin hLocal Health eDistrict. accordance with San Joaquin County ordinances, State laws, and rules and anddyregulations o q(Owner and/or Contractor) Si ned 1l �"" ---------------------------------------------------------------------------- ( �q )-•---- -1 ------------------- ------ ---------------- - - -- ----- -- - - - -- --------------------(Title--------------------------------------•--------------------- -- - (Plot plans, showing size of lot, location of system m relation to welts, buildings, etc., must be filed with this application). � FOR DEPARTMENT USE ONLY DATE...... 'L a - ----------------------------- APPLICATION ACCEPTED BY ---------- --------- ------------- ----------------------------------------- DATE-----=-------------=-------------------------------------- REVIEWED BY ----------------------------- --------------------- BUILDING PERMIT ISSUED ---------- ------------- ---- ------ --------------- Alterations and/or recommendatEons-------------------------- -----_-______•_____________--______-_ ------------------ '---------------•----- 'z- 5 — s v. -------------------- _-- =Date `FINAL INSPECTION B :"----- ----- ----- - ----- ------�--- -- i,ERMIT No. --------- ISSUED---- -- -- s ' - Date_ SAN JOAQUIN LOCAL HEALTH DISTRICT t 13Q South American Street Stockton, California E$ --9-2M 9-50 W=1639