SU0003892 - Laserfiche WebLink

Home Browse Search

F_OOFFICE USE: .--_._..............................._--.... A..PLICATION FOR SANITATION PERT IT Permit No. -1.4...... ------------------------------------- - ---- - (Complete in Duplicate) 6 This Permit Expires 1 Year From Date Issued Date Issued -..�--- .- . 3 Application is hereby made to the San Joaquin Local Health District for a permit to con truct and install the work herein described. This application is made in compliance with County Ordinance No. 549. ) A Ac; of (� !! / JOB ADDRESS A L 1 CS '�,�__.. i.:-. - '... - Owner's Name.---- !. ,- ..... - 1�._.................................----------------------- Phone-7-'.W..o -76-Z ffii ------------------------- M --••----------------------- Contractor's Name-.' -- - - - ----- .. ._ t .-... ------ p ---- Phone-�p..6�.�d . - ..--- - Ins+allation will serve: Residence �rfinent Ouse ❑ Commercial ❑ Trimer Court ❑ Motel p Other ❑ e Number of living units: ---I---- Number of bedrooms _2j Number of baths 4..- Lot size .Z�7,10-------�._._r7-IJ........... Water Supply: Public system ❑ Community system ❑ Private P-15epth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,dote................._-I No ❑ New Construction: Yes ❑ Nq4—FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: Z/T' (No septic tank or cesspool permitted if P#L.Ilewer is available within 200 feet.) ---- Septic Tank: Distance from nearest well_ ..E/-- Distance fro tfoundAtion.. ..(� Material ) .... No. of compartments_._. Siz �c2 _xC.B...-Li uld de th...1�w.......---.--Ca acit �Om 7/,�---._- _ Q-- - -. -- q --- - p y.. -------' � Disposal Field: Distance from nearest wellol(J_..---Distance from foundation-_1. -----Distance to nearest lot line--- �..__. Number ofe Length of each line--- _......._-_Width of trench.s ��.............�-.. Type of filter material._ 1 ..1�_Depth of filter material.-._-__��C/!!-__Total length......_-_.,_._..._�, i-Q........ n - �. Seepage Pit: Distance to nearest well.........------------Distance from foundation------------------Distance to nearest lot line.............. ... i ❑ Number of pits-------------------Lining material------------- ....----.Size: Diameter-----------------------Depth---------------------------._.- S Cesspool: Distance from nearest well-----------------Distance from found"ation._-..............Lining material...._......_..___...___._.4,,--_. ❑ Size: Diameter----------------------- ------------Depth................................ --------------Liquid Capacity------.....................gals.,V Privy: Distance from nearest well.-...._-.__----------------._._--_....__.Distance from nearest building.......................................... , ❑ Distance to nearest lot line------------------------'-------------------------------................._.---_-----.........------------------.........._..----------- 1 Remodeling and/or repairing (describe):.-- -------------'--------'.......--------- ---------------"-'-----------'-.....-------------'-'----------------.__................................................................--------------------------------------------................................... ------....--------------------..---`---------- ...._.......................................-........-----------------------------------------------------------------------'-'------------------------- I hereby ce 'fy that I have prepared this application and that the work will be do a in accordance with San Joaquin County ordinances. la ards1c s and regul ions of the San Joaquin (L/qtal Health Di rict. ,�,�y��, ........ ---' 3.L11"°>_. ---- ------------------------------le` r•By rr Contractor) By:----'-'-'--'-""-"...................--- ----------------------------------- -- ...(Ti+le)------------------------------------ - - --- - (Plot plan, showing size of lot, location of system in relation to ildings, ebe placed on reverse side). FOR DEPARTMENT USE ONLY / APPLICATION ACCEPTED BY-------------------------------------------- --- 5- ........................ DATE--- / .lr •----------------- REVIEWEDBY........---------------------------------------------------------...' . ...................---------.................. DATE-----------------•------------------------------------- BUILDINGPERMIT ISSUED.........---------------------.....................-..................................... DATE------------------------------------....................... Alterationsand/or recommendations:------------------------------------------------------------------------ ................_.............------------------------------....................... ........................ ..............-................. ---.---............----------....................-....................................-----......-........................................................ ---------- ---------- ........'.............................--------................-------'-------...................................................------...................... ........................... .............................................1---......----........----.............--------'--•-................................ ......•....------............----- --------------------------------- FINAL INSPECTION BY:. -------------- /-.(/_S.............................. Date ....... ...� �- 2 ..._---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha,elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca, California Tracy,California ES 9 REVISED 0-59 3M 3-'63 r.P.Ca.