15304 - Laserfiche WebLink

Home Browse Search

FOR OFFICE E: � - /��. = 3 APPLICATION FOR SANITATION PERMIT Permit No. _ .. ------------ (Complete in Duplicate) ..................y'--_...-__ -- �. Date Issued !,.-1•�-•-•G� ------•---------------------- This Permit Ex fires 1 Year From Date issued -----------.------------------------- Application is hereby made to the San Joaquin Local Health altDiNoc for a permit to construct and install the work herein describe . This application Is made in compliance with County Ordinance JOB ADDRESS AND LOCATION----- --------- ---Q.� .... Phone...............-----------••-------- Owner s Name....._______ -i p�•�.-��- ------------------------ ------------------------------------------- Owner's --------------- •------------- Address-----•------•------•--••-... A L�1 �✓_. ----------••--- -------------------------- Phone....... i r, •-•------•----- JJ Contractor's Name----------- ....---- -• Motel Other 1� Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ ❑ Number of living units: _----_-_ Number of bedrooms _______. Number of baths -------- tot size .____.•• ft tPrivate. epth To Water Table 7 •• Water Supply: Public system E] Community system ❑ ClAdobe ' _ .,ardpan ❑ Character of soil to a depth of 3 feet: Send [3 -Gravel ❑ Sandy Loam ❑ Clay Loam ❑ y ❑ ANA Yes E] No' s Previous Application Made: (If yes,date.._.----_----------) No New Construction: Yes ❑ Nom TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I r� C , - ------- --- /� Septic Tank: Distance from nearest wel _f p-------Distance from foundation u d depth__ Irl------- Capacity...- a. ........... �/ No. of compartments---•-- --------Size.----: +�- q Distance from foundat•on..f a--I--------Distance to nearest lot line--_-15- .--- Disposal ed: Distance from nearest well- ------ Q Width of trench.__Q =• ---- 01 oe Number of lines___. 1l--------- ---------Length of each line-.( - C� • Type of filter mote rial..-'Y 4C:- ---Depth of filter mate rial_-_ _, - � Total length---.-e`----•----... �.. material_-.------•-------------Size: Diameter----•-------•-----•---.Depth-------------------•----- ------ Seepage Pit: Distance to nearest well ---------------Distance from foundation--------.-------.--.Distance to nearest lot ine------------ .. ❑ Number of pits----------------------Lining -------------.-_-Distance from foundation .-.---._-._..___--.Lining material-------------------.--------.F_ • Cesspool: Distance from nearest well _Liquid Capacity gals Size: Diameter--------------•----------------------Depth--------------------------------------------------- 171 ---------------- ------------- ❑ G :Distance from nearest building-----•---•----------------•-------------•- Privy: Distance from nearest well---------------------------- -------------------------------------------------- ---------- ❑ Distance to nearest lot line--_---------------------- / ----------------- -- ----•--.-- E1 = �aa-_7----------- Remodeling and/or repairing (describe]------------------ ----- ------ . -------------•--------------••------••------- _ .-I hereb --certify that I have pre ared this application and that the work will be done in accordance with San Joaquin County y ordinances, State s, and r a la+ions of the San Joaquin Local Health District. __(Owner and/or C , trac+or( -------------------------------------------------------------------- (Sig , `a (Signed!-------- I By: -------- ------------------------- -------- (rifle) plan, showing size t, location of system in relation to wells, buildings, etc., can be place on reverse Side. FOR DEPARTMENT USE ONLY DATE.... APPLICATION ACCEPTED BY ----------. DATE---------------------------------------------------------- REVIEWED BY------------------------------------------------------------------ -------------------------- . _ � DATE-----------,-•---------•-•-------------�,----------------• BUILDING PERMIT ISSUED-------------------------------------------------------- -..----- --••--------•------------------------------�_ - --- -- �_--- � T1s -�' Alterations and/or recommendation ----- - �� cY f --------------------------------------- ------------------- -------••--------- / Date-----/ ------------- ----- ..... FINAL INSPECTION BY:. _..� ----------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT �^ .205 West 91h STreet 300 West Oak Street 124 Sycamore Street 130 South American Street �'Tra�y�Caiifornia Stockton,California Lodi,California Manteca,California e ES 9 REVISED 5.59 2M 5-62 ATLAS a , s..