15562 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE, -- -------------------------- Permit No. _ - -------------------- -- --- ------ -------- ---------- APPLICATION FOR SANITATION PERMIT 4 __ ___---_-.- � (Complete in Duplicate) Date Issued --------------------------------------------------------- --- __ _ _ _ _ ___ This Permit Ex fres I Year From Date issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descrbed. This application is made in compliance with County Ordinance No. 549. f JOB ADDRESS AND CATION._IO- ---- girl,_ ..__ � Phoney` �'� Owner's Name-.. ----------•- ------------- ------- o i f .... `/� Address---�---7• -- T_ 4 `a...-_� ------ •---- !• Phone .. ._.. Contractor's Name_- .... .................... ?Motel ❑ Other ❑ Commercial � Installation will serve: Residence partment House ❑ ❑ Trailer Court ❑ Number of living units: Number of bedrooms _ember of b kis -------- Lot size - _------_---._-- l Public system ❑ Community system ❑ Private Depth To Water Table .------- it.Water Supply: Pu y e ardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Previous Application Made: lif yes,date- ----------1 No ❑ New Construction: Yes ❑ No Wr FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank or cesspool permitted if public sewer is available within 200 feet.] IMaterial--------------------------------------•--------- c T : Distance from nearest well-- ..-_---_.Distance from foundation----------------- -- � No. of compartments--------------------------Size------- •-•-------•----- Liquid deR�---------- ----- ----•---Capacity F t on -..Distance to nearest lot line_- `... osal Distance from nea t well--{., -1p---_--Distance from foundation_. _ Number of lines Length of each line.�-0a-`-__4_2_47Wkdth of treneh__ _4 !-••--------- .__Depth of filter materia --------Total length_-..__.��.•'�---••---•-----•- �� Type of filter materialelc p pa it: Distance to nearest well------------- ------Distance from foundation .-__-.-_..-_.-_-.-_.Distance to nearest lot line._--.___..___._-- O j Number of pits------ ---------------Lining,material----------------------.Size: Diameter Depth ------.Lining material .. s Cesspool: Distance from nearest well---..--_•--------Distance from foundation_____________ al . -Depth ------------- Liquid Capacity ------•9 ❑ Size: Diameter--t---------------------• P . Distance from nearest build ing----------------------------------------- ------- Privy: � Distance from nearest well ------------------------- ---------------- ------- ❑ Distance to nearest lot line____.-----•----•--------------- --------- ----•---------•------- '' Remodeling and/or repairing (describe ' -- ------------------- - --------------- I I el --------------- ..__ ---- ------- ----------------------•------•--- -------------------- ------------•--------------------•-------.----- f •------•----------•----•---•-----•-- --•--------•--------------------------------------------- hereby certify that I have prepared this application and that t work will be done in accordance with San Joaquin County ordinances, to I s, and rule and regulations of th an Joaqui Local 4Di-:sfric+. ! r /or Co-------------- ntractor Si reed ---- J By: -�I ------- ---------------------- - ----- ---------- -------------{rile)----•--------- ---------- --------------- -- -- --- -------- � -------••--------•----------- - -- (Plot plan, showing size of lot, location of system in re on to wells, buildi s, etc., can be placed on reverse side). --------------- FOR EPARTMENT USE ONLY r DATE- -/.---------•- •- APPLICATION ACCEPTED BY �- DATE-------------------•--- --••-------•-----------•- - REVIEWED BY- BUILDING PERMIT ISSUED---------- ------- ----- ---------------------- --- AFterations and/or recommendations:--------------- --------------------------------------- ----------- •---• •---•----•.................... ---•---•----•---------------------- •.. -------- ----------------------------------------------------------------------- --•-------•---•--•-•----•--- ----- . ----------•---•---•---•--. Date---- ?------ I ------------------------- ----------- - FINAL INSPECTION BY:..-.- '----- --- . SAN JOAQUIN LOCAL HEALTH DISTRICT r 124 Sycamore Street 205 West 9th Street 130 South American Street 300 West Oak Street Stockton,California Lodi,California �- Manteca,California Tracy,California ES 9 REVISED 13.59 2M 5.62 ATLAS