4005 - Laserfiche WebLink

Home Browse Search

,. Permit No. .---�f--L--��' APPLICATION FOR SANITATION PERMIT y (Complete in Duplicate) Date Issued _67 Application is hereby made to the San Joaquin Local Health District for a permit to construct and ins+all the�okei ri ed. This application is made in compliance with County Ordinance No. 549. JOS ADDRESS AND LOCATION..___ _ .0 C— ' Phone Owner's Name----------------- --: 2 Address - - ,9 ! � --------------------------------- Phone Contractor's Name--------/1- _ /& . �-a0C Installation will serve: Residence F1Apartment House El Commercial ❑ Trailer Cour} [3 Motel ❑ Other Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size ----------------------------------------------------------- Wafer Supply: Publics stem ❑ Community system ❑ Private K Depth to Water Table -------- ft. y > Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [2 Clay Loam 02 Clay ❑ Adobe LW Hardpan Previous Application Made: Yes g No ❑ New Construction: Yes No ❑ TYPE OF INSTALLATION AND_SPECIFICATIONS: (No septic tank or cesspool Permitted if public ewer is available within 200 feet.) --!-�---------Matenalit Septic Tank: Distance from nearest well._�_OQ-____-__Distance from founda#ion__ - 7 -Ca a itY nts- ------�---•--'---Size------- epth_____-�'.- No. of compartme ----IP _____._._.Dis#ante #o nearest lot line_ ____0- ------- Disposal ______Dis osal Field: Distance from nearest well_ " ----Distance from foundation _____ 1VQ ----Width of trench----------- ---------------- Number of lines---.---7------------- Length of each line--------- - G� Type oT filter material _-- U.G�S.-----Depth of filter material-__.__A P------------Total length_____________Z .___. Seepage Pit: Distance to nearest well_____________________Distan e from foundation Diameter-_ Distance toDnep est lot line_-----..-_---- ❑ Number of pits ---------------------Lining ma ` Cesspool: Distance from nearest well_________________Det+hce from foundation--------------------._.___Liquid Capacity...._ .______.._ _________gals. Size: Diameter------ --- -- - -- -' ------ 0p . ..- - _ iv : � Distance rom nearest well___ ___-----------------------Distance from nearest building ------ --- -'- ❑ Distance to nearest lot line--- ----- ------- ` ---------' ------------------------------------------------------- XA,---- ------------------------------------------•---- Remodeling and/or repairing (describe:---- .- -1. 1�[.--- f" - --- -----•-- - • ----------------------------------------- --------- ------------- ---------------- - i ---1 : ---------------•--- ------- --- i I hereby certify that and rules ulespre regulations plication the San Joaquin Local kHeal Health trict� accordance with San Joaquin oun y ordinances, State (Signed)---�•------- -' _:4.=--. --- - - ---- - __ - --- '---------------- ------------------------------------------------A. : ---_�wner and/or ---o-�-n- rat-�or TltIe ------ ----- � - -----'- - BY�................................ (Plot plan, showing size of lot, location of system in relation to Wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ---- ---------------------------------------- DATE---------- APPLICATION ACCEPTED BY_ ;r �,-�5--� j --------- ------- ------------------------ DATE-- - ----7-------------------- REVIEWED - -- --------------REVIEWED BY-:---------•-------------- •-----'•--------- ----- - _..----'----•---• DATE-•-_--=------------------ ---------------- ----••------ -• BUILDING PERMIT ISSUED------------------------------------------------------------------------------------ -------------------------- ---- ---------------- Al+era#ions and/or recommendation,liar �e -� -- Q . 1 y� -- _„- - --- ' ----- ---te- -------------- 7---- --�`-- ” = " ---------- iiC�l uC s•�G- �/ FINAL I�,�p I!�lll SPEC71 -BY:- Date--=------------ --~ - �----- _4?------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Trac California Stockton, California Lodi, California Manteca, California Y�- ES-9-2M 10-52 Revised W-2100