12213 - Laserfiche WebLink

Home Browse Search

l z 3. �1 APPLICATION FOR SANITATION PERMIT Permit No. -------------••------- (Complete in Duplicate) Date issued -----!6/4 This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and 'install tth_0400 herein described. This application is made in compliance with County Ordinance No. 5449. $_r cow JOB ADDRESS AND LOCATION_ t_ Phone---•----------------•--------------- y .1 y-�". Owner's Name___________ = s Address-------------------------- r '4 Contractors Name----------------- --- ----------�--------------------.----❑--------------------------- •--�------ Pone.-------•-------•-•----•---•---•-._ Installation will serve: Residence Apartment House Commercial Trailer Court ❑ Motel ❑ Other ❑ Number of livingunits: __/�____ N bar of bedrooms _Number of baths _-__:- 4 Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table _� ft. , pp y: Y Y �, / Hardpan Sand Loam L� aY Loam ❑ Clay ❑ Adobe❑ ❑ Character of soil to a depth of 3 feet: Sand Gravel ❑ Y Previous Application Made: Y New Construction: Yes No ❑ FHA/VA: Yes ❑ No ❑ P TYPE OF INSTALLATION AND SPECIFICATIONS: -- (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from founds#ion------------------- - Material___-.__.__-----p"-----y_-.__-�----�:--•-::•� -�- No. of compartments-- -----------------------Size--------------------------------Liquid depth-------------- -----------Capacity-_---------- Disposal a aci# *� istance Disposal Feld: Distance from nearest well"" """"__"^__DLength of from each 1 ne anon-------- --- - ---DV dthcofttrenchest lot line----------------- Number of lines---------------- Total length------------------------------------------ ❑ Type of filter material________________________Depth of filter matenaL___._________________ Seepage Pit: ❑ Distance to nearest well------- -- Distance from foundation - Distance to nearest lot line----------------- Number _--_---------: Humber of psis._______ - -nin9 material -------------------- --meter "" Depth Dstance from nearest well fro foundation__t,4 ----------Lining mater,al_ �---------------- Cesspool: ----------------------- -------------Liquid Capacity_._ ---•--gals . Size: Diameter11X_(0"X e ------ De t ___-------------------------------- - Distance from nearest building------------------------------------------ Privy: Distance from nearest well Distance to nearest lot line-----------------------------------------------------------------•---- 15 Remodeling and/or repairing (des 'be)*------ . �� -,--e-------------------- ------- -'----- r-- ` f _ a— f --f -------- -- , --------- ------------------------------------------------ I-------------------------------- -- ------ ---------------- ---------------------------------•------------------------------------------------------------------------ 1 hereby certify that I have jespandr regulations application lf the San Joaquin LocalkHeall heDistnc}n accordance with San Joaquin County ordinances, St e laws, and ,�i • /'"�- -------_ .-_-___(Owner and/or Contractor) ------ ----'------ --------------- _ (Signed)---- -- --- ----- f I `- _ __-_--_ ----------------(rt ------ -- e SyT=----:-------- -:---•:--------- (Plot plan, showing size of lot; location of system in relation to wells, buildings, etc., can be placed on reverse side. FOR DEFAitT ENT / E ONLY APPLICATION ACCEPTED BY____-_ _ =_t---- x -- -- - ------------------------------ :-- ----�.�' G-- REVIEWED BY----------- --------------------------- -------------------------- --------- -------- DATE------------• ---------------------•----------------------------- DATE-- - --------- --------- ----- --------------------------- -- BUILDING PERMIT ISSUED"___---•------•--- --------- ------------------------------------ •----------------------- Alterations and/or recommendations-------- --------- -------- --- ----------------------------------------------------------- --------•--------------------------•----•-----""-- ----------------- ------------------ ------- •----- ----------- --------- --- --•------ :------------ g' , �- ----------------------- ----------- ---- ------ Date_.------ �-- _------- ----------------- FINAL INSPECTION BY:------ ------- ----- �------ SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street 130 South American Street 300 West Oak Street Trac California Stockton, California Lodi, California Manteca, California y� ES-9-2M Revised B-'59 P.P.Ca. -_--_.