SU0001399 - Laserfiche WebLink

Home Browse Search

---------------- ...... ... .. .. .. . APPLICATION FOR SANITATION PERMIT Permit No. .__:'_-�.. ,' `� (Complefe in Duplicafe] I�'). rJ� -•----------------------- --........-------.......... , ....... - -- .-. ... This Permit Expires 1 Year From Date Issued Data Issued .........:..:. ........ Application � hereby made to the San Joaquin Local Health District for a perm+ to co truct and install the_)%prk,4Lerain described. This application is made in compliance with County Ordinance No. 549. .1- k ria teCCL/ `j / I JOB ADDRESS AND LOCATION._.. I� f r z-` - r . r, 1 - Owner's Name- . �= f . --_, %L...."c�-----. -- r _---- -- = t-- - � . ------- ----------- ---- -- ---------------------------------- Phone................................... Address_ _ .......... . Contractor's -------•---•---•------•------•-- •------------ .......... -----•----------------- Phone................................... Installation will serve: Residence Z Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other p Number of living units: Number of bedrooms._._ _.. Number of oaths _____.. Lot size ............................................................ Water Supply: Public system, p Community system ❑ Private ID Depth to Water Table -7:q- ft. t Character of soil fo a depth of 3 feef: Sand [] Gravel ❑ Sandy Loam I@ Clay Loam ❑ Clay [] Adobe❑ Hardpan ❑ Previous Application Made- lif yes,dote ) No New Construction: Yes [�j No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic fank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-Xd........Distance froryl foundation- _j.47-.-.--- --Material-----._!'_!_-.__ -------- - 1�--' ._ Liquid de th--------�_--- -.-.----•--Capacity./ { ] No. of compartments---..:` -----------------Size- `'_y q p l�� 1___-- -------•- ` t)Disposal Field: Distance from nearest well i ..Distance from foundation__:' ............Distance to nearest lot line_`. _._..._.___ [7 Number of lines._- _Vet?_--__ --------------- ---- Length of each line_---�.q-_--- -------Width of trench----•:^: - •---._._..._. ii ____ Type of filter materialC '�'�_�'j%E'�Depth of fitter material-.---.-/.�..'-___-,Total length_-_�:Ya'______________________ Seepage Pit: Distance to nearest weil.............. ......,Distance from foundation.......-------------Distance to nearest lot line................. ❑ Number of pits--_---_--- -------Lining material.......................Size: Diameter.......................Depth................................. Cesspool: Distance from nearest well- ---------------Distance from foundation....................Lining material..................................... ❑ Size: Diameter................. .....:... . _.._...Qe th................................ P -- .---------------Liquid Capacity---------------------------- - Privy: Distance from nearest well...... ............. ................... . .....Distance from nearesf building.......................................... ` [� Distance tb nearest lot line._. . Remodeling and/or repairing (describe)---- ---- ---- -- --------------------------------------------- ----------•-•----------•-----•--••-- -•---- -----------------•-----•-------•-----•-- .--------•--•---------•--------------•-------;-------------------•-----•-----•-•------------------ ------------- -•-•----•----••- ••---••---._.--..---•--•-----•-••---.............------•-•--._.._...----• t 1 -•-------------•-----------•---------- ------------------------•••---------------------•----- ----------•••-----•------ .......-.--------•-- -----------------••--- -• ----•------ ----•------ ---•--------•-••----•-•---- --------------------..._.............--......................................... .. I hereby certify f I have prepared A's application and that the work will be done in accordance with San Joaquin County ordinances, State ws, 9fTd rules and regul ions of the San Joaquin Local Health District. ! {(Signed) l c_---- � , � . 9 )-------•• . -� - ..-. _ .-.-.. r ....... .......... -------_- -----_------- ----...(Owner and/or Contractor) By:-•-- -•--- ...._• ---------- ------- ----- ----- - Title ... ....... (Plot plan, showing size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse sidel. i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTf� Y._,--/"_:':_:.:.:..:- :..------- - •---------- • DATE..---_7-2—!-'F.2------......................... REVIEWED BY.......... ........................ ---1_-___,____... -- ._ _.--------------- ••-•------------- DATE--- T"-!��.."_�. ~..__.._.... W ........ BUILDING PERMIT ISSUED............... -- - -------- ... . ......... . ---.... .............. DATE............................... .-.... ...-... 4 Alterations and/or recommendations:-- ... .. . . . . .. ... _....-........--•........................... ....... - ...... _.. .. ............... ........................... :............. i -----_--- ............. ....... ....................-- -.--.---------..._.---•---------------------__-.--•-----•-- -.....--------..._.__.._ ............................ --•-------- - ----------------------- -- - - _.._...... ......-_-_...-..--- --__-..-------.------.---_... ---------____-__ ___----- •----------________-_-•••------•--.------•-• ._... ................................... .. ._....._... .... . .......................... ...... --- --...-• ---------- ------------- ....................•-•---------•------_ --------- FINAL INSPECTION BY:..- : .. . . Date.-..7.' '`" �r '............ ..........:......... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak sneet 174 Sycamore Street 205 West 9th Street Stockton, California Lodi,Colifornia Manteca, California Tracy, California ES 9 nFV15E0 n-59 71M n-r2 ATLAS r