SU0003892 - Laserfiche WebLink

Home Browse Search

............ )...PLICATION FOR SANITATION PERT Permit No. ..�J-.Lt ........... ............................. (Complete in Duplicate) 41 ......................... --- This Permit Expires 1 Year From Date Issued Date Issued J..//_X/4- Application is hereby made to the Sen Joaquin Local Health District for a permit to construct and install the work erein d crbed. This application is made in compliance ith County Ordinance No. 549. JOB ADDRESSD LOCATION .. — ,_„•1 -g ! -----------_-----• ...... Owner's No + - I--• --- •...........-- ... Phone--... - .................... Address--- ...aS._.. Contractor's Name--•-------'--'-- ....-----.. Phone--............................. Installation will serve: Residence [—Apartment House ❑ Commercial ❑ Trailer Court ❑pMotel ❑�O,th-orr ❑ Number of living units: _/-... Number of bedrooms cl Number of baths -./-. Lot size _90� __ ............................ Supply: Public system ❑ Community system ❑ Private19 Depth 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,dpte:...----___...-_) No El New Construction: Yes ElNo�' FHA/VA: Yes [- No E TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) is Ta,” Distance from nearest well.................Distance from foundation...................Material........-_-.............................. No. of compartments.... � �-.Size................................Liquid depth.....__--.__._...----.-Capacity.....-_.__._...._.... Distance from nearest wells,J./D_....._Distance from founds ion.,�Q_--......Distance to nearest lot Ili... ......... Number of lines......... Length of each line.&_!.. b_..,._..Width of trench__y72.l�......./. ......y._... Type of filter material .,t- ...Depth of filter material...../.d---------Total length-_-.-._-...._.... ------- Seepage Pit: Distance to nearest well---_.................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________-...________---...........N- ❑ Size: Diameter--------------------.................Depth-------------------------------------------------.--Liquid Capacity...........................gals. Privy: Distance from nearest well----------__---------------------------__.__Distance from nearest building.......-........................... ❑ Distance to nearest lot line-------------:.......---------------------------....-.....-----.................................... ........................... - Remodelingand/or repairing (describe):....-----------------------------------.......................................... - ------------•-•-----•--------------- I hereb .certify at I have prepare t is application and +h t the work will be done in accordance with San Joaquin County ordinances, s, and rat end re u tions of the San Joiquin Local Health District. (Signed)..._. .. .. .. ...................................../1�- ----- ,.... ........................ r and/or Contractor) ------------------- (Plot plan, showing size of lot, loca+ion of system in relation to well moldings, etc., can be placed on reverse side). R DEPARTM T USE ONLY / APPLICATION ACCEPTED BY.. - - - DATE. - f Gam---------- - REVIEWEDBY. ...:--............_ ................-_----------------------------------------....._--------------------------• DATE---...-' '- - - - ---'-"- ---••... -- BUILDING PERMIT ISSUED....................................------------------------------------------------------------- DATE....................---........ ........................ .. Alterations and/or recommendations;----------------------------------------------------------------------------- ------------------------------_-------•------------------------- .. ..........----".....-........ ---------'-"--'--"....... ................................... - ........................... ........................----............................... ................ _.....................---'-......'•'- - - - - - -- - - - - - ....................................................................1 .. ..... .............. L3 ..........................................................t..../..._...-............_._ -__-___..__.......:................... FINAL INSPECTION BY:.... .. ----------------------- - - - Date l // -'»<........................SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Soath Amvican Street 300 WW Oak Lnsl 174 Sycamore StrNt 205 West 911,Street Stockton,Callfornia Lodl, Californ!a Manbco, California Tracy,California Es 9 REVISED 8.59 2M 5-62 ATLAS