SU0011507 SSNL - Laserfiche WebLink

Home Browse Search

// R OFFICE USE: r �. •--l� �� ••-- •. l4--- -- -_-- - _•--- - - Permit Na, .1....._�..`�._.•.,l-•• APPLICATION FOR SANITATION PERMIT ---------- (Complefe in Duplicate) Date Issued ... �•5 I— _- . } This Permit Expires 1 Year From Date Issued Applicafiion is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. © ,• S— /00— Z. JOB ADDRESS AND LOCATION---•'-_._-/_.P_� �. -_A&--- ----- � Owner's Name.............. ........... --L�'�1.4/_•P_S��_�_G'_.�.d.�:'�1-----------._.------- --------•---- -•--••----••• Phone.... �`.. � /t -------------- -----•-----•-------- Address J.. .--00 1 . Phone---o /�� ,7 Contractors Name.. ' Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _L. Number of bedrooms __-.12-Number of bathsj........ Lot size -......r0' ,��a.'e------------- V1/ater Supply: public system ❑ Community system ❑ Private Depth to Water Table _-_.__ ft, t f Character of soil to a depth of 3 feet' Sand ❑ Gravel E] Sandy Loam El Clay Loam Clay❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date....................I No �ew Construction: Yes E] No HA/VA: Yes ❑ Na [�''� ' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feef.lor # . Materi&I_....dP !!GC�.i �� .............. Septic Tank: Distance from nearest well..----Distance from foundation...r._ c ` n uid de th L' •••---- Capacity_.egp• No. of com artments........._..�---------_Size____l01°_ .7''.. _.Lia, p. , 1 p _ Disposal Field: Distance from nearest well-1V----Distance from foundat o ... ,5..•..--•Distance to nearest lot line.- � Len th of each fine._..____ '" Width of trench--_-. ... ._. g �_.. Number of lines--___-•-- ---------- �� p � - 1 ° .._Distance fr m foundation._._.•.Q.__.....Distance to nearest lot line.,�✓�__�._ Seepage it: Distance to nearest well../ _.-Size:Size: Diameter....-_ `d _ Depth.--_mss -r-- S L9' Number of pits..... Lining material. /"_� - Cesspool: Distance from nearest well_________________Distance from foundation..._.._..._....._._.Lining material...._-_.__-....__....._____._-•-als. ❑ Size: Diameter---••-----------• --------------------Depth--•-------•-=----•-----••------.---------------.._.Liquid Capacity.....•••-••......--.........g A Privy: Distance from nearest well-------------- _' �,ri Distance from nearest building-----_---------_--•--------------------- -•---......---• Distance to nearest lot line__..•.-•-----•-•---------••--•--- ••---•---�=-=--::--•................................ ... --.•__.. fno Remodeling and/or repairing (describe):..---_-•.0 �' ........................r.I ------------------------••-------••----......_......---....__..•-•-•-•. ...•---•-•_•-••. •----------•------•---•----•--•...-•••-•......----•-----• 1 --------------------------------- '. •. I hereby certify that I have prepared Phis application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and r regulations of the San Joaquin Local Health District. ' r or Contractor ........ .:... . .. Pl.. ;aY''?' �'"' �''��Z (Signed) (Title) /• ........................... ' By:............................. •-- - _ buildings, etc., can be placed on reverse side. (Plot plan, showing size of I , locatrion of sysfe in relation to wells, FOR DEPARTMENT USE ONLY DATE------ � ��°----------- PP ' ALICATION ACCEPTED BY.---- -•----.._...--• --._....... DATE -------••---- REVIEWEDBY_----------------------------- =- ----------------- = .� a. r_ DATE. BUILDING PERMIT ISSUED--------............. -------- ----------------------------------- -------.- Alterafions-and/or recommendations:..._-.... . ��—� .. �..... y _.ti _ . Z�l g - � - •----••------�------- ��,�_,�c motif_. � 1,.� ........................................ ' Date....._..:�._.�/....._.. ....................................._....---- FINAL INSPECTION BY;_ ...-� •----------- f ' SAN JOAQUIN LOCAL HEALTH DISTRICT 1801 E.Ha:slton Ave. 300 West Oak Street i 24 Sycamore Street 205 Wesi 9th Street ' Lodi,California Manteca,California Tracy,California a Stockton,California x F.P.C .