SU0004380 SSNL - Laserfiche WebLink

Home Browse Search

-------------- _______a AI'''11CATION FOR SANITATION PERI` Permit No.(F ---------- --- --------------------------- (Complete-in Duplicatel . ---------------------- --------- This Permit Expires i Year From Date Issued Date Issued _/.�_7::A{��SX11, Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. S49. JOB ADDRESSFVANL CATION__ / bl----C r Owner's Name_ -- - - - ---- -------------------------------r-------------------------- •--------- ---------.- Phone.._ -_.7 A cess_.. -------•-------- Contractor's Name------- .__. - Phone............ .............. Installation will serve: Residence [� Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __I___ Number of bedrooms -------- Number of baths -------- Lot size ----- ___ __________ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table ------ _ ft Character of soil +o a depth of 3 feet* Sand ❑ Gravel Ej Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0—Hardpan ❑ Previous Application Made: (If yes,dote----------___.... ) No [Z'_ New Construction: Yes No ._ ❑ a___F,HAJVA. s,K No FTYPE OF INSTALLATION AND SPECIFICATIONS: c4l�� (No septic tank or cesspool permitted if public sewer is available within 200 feet.) SepgtiankrDistance from nearest well_________________Distance from foundation--------------------Material._______-___--_-:_.__.__.____._______.___.______. No: of compartments Size------- ------------ -•-----Liquid depth--------- ---- -- ---- -- Capacity----------------------- r— Disposal Fierd: — Distance from nearest well_________________Distance from foundation...____..._____-_--.Distance to nearest lot line __.__.____. ❑��l Number of lines.----------------------------------Length of each line__.---------------------------Width of trench---------••-------------•---------- Type of filter material_________________________Depth of filter material--------------.--------Total length----------------------------- Seepage _____.._-_____-__.-______-- Fp�it:. Distance to nearest well`fl��`_____________Distance from foundation__�_r___.__-.Distance to nearest lot line--�.��_-. See a e P Number of pits___ -1---- Lining material Size: Diameter---.� --.--_.----Depth-----��----------- \ Cesspool: Distance from nearest well ______________ _Distance from foundation----------- _Lining material__.______..-__._______ ---- ❑ Size: Diameter. __ .-. depth --------- ------- --Li Liquid Capacity i - q P tY-- •------------------------gals. Privy: Distance from nearest well_____________________ .--_____.__Distance from nearest building ❑ Distance to nearest lot line------------______ r - . -- ------•-•-------------------------------------- -------------• •-------------- Remodeling and/or repairing (describe):_____- , - - ------- -- ------ -----•----------------•-------------...- ------------ --------'. �/ -------•------- --•---------•--------•--- -----------------••--------••------------------------..-----------------------------------------------------------------------------------I——-----------------••---------------- ;.z I hereby certify tha+ I ve prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, a ru and re la ' ns o the San Joaquin Local Health District. (Signed)---_------------- --- - ' -- -------------------- ---- ----------- -----------_(Owner and/or Contractor) By=---•--------- -----•-•-------------------------------- ------------------ -- ----------------------- •• - -- - - - ------------- ------ -----------•-----------•-•-----------------(Title)--------- -- ---------- -- ---------- - -.-- (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 I APPLICATION ACCEPTED BY--------------- ='=---_•----.------------- - ----------------•----------------------------- DATE-------- �• REVIEWED BY- --....................-•----------------------------------------------------------------- DATE ------------------------ ---------•--_------- -� BUILDING PERMIT ISSUED__________ ____ ' --------------------------------- ----. DATE-.------------------- -------------------------•-•----------- Alterations d/o .recommen aci ns:----------____ ___- __ _ -- ----------------- -------•------------------- -----------.-------------------------------------•-------•----•--•--------- -. _ , -�---------- - ---------------- --------------------- ........ -----•----- -------------------- ---------•--------•---------- I - --------------------------------I------- ------ FINAL INSPECTION BY:-.----.-.--- --------- ------ Date------- - 7 171 SAN JOAQUIN LOCAL HEALTH DISTRICT �� fl 1601 F.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi. CaliforniaManteca, Tracy,California California I E.H.9 2M 1.67 Vanguard Press