SU0003452 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: A.--eLICATION FOR SANITATION PERtwiT Permit No. ..--:_:-------:------- -------------------------- --------------------------- (Complete in Duplicate) ----------------------------------------- _______________ This Permit Expires 1 Year From Date Issued Date Issued 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. 549, j JOB ADDRESS AND LOCATION -� �`� ' d_v --------------------- F Owner's Name----------- o --- ------ ------ -------------- ----------- ..,Phone-------------------------------- Address------------------ 3•-$d�--_--•-----�' 4 `� .-----------------------------------------.--.-------------------------------------•-------•--.--------••-•----- :. I Contractor's Name--G�i.Ai".1 N_�`- Cc J- rte,..-Q:------------ ---•-------------------- Phone----------------------------------- Installation will serve: Residence M— Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms _ ___ Number of baths -------- Lot size _--_�_C_G-__g____ .Q__�.---------___-_-_._ Water Supply: Public system ❑ Community system ❑ PrivatejX 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,date................----) No ❑ New Construction: Yes ,e No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION:AND SPECIFICATIONS: (No septic tank or,cesspool permitted if public sewer is available within 240 feet.) Septic Tank: Distance from nearest well----6-0---Distance, from foundation-------L1___.Materi�--- !v_4 ✓_e_.1__' No. of.compartments-------- i �---------_--Size_jAX_6__x__�---•---Liquid depth __ � __________Capacity.l-as5P__ . �4 f p 1 f Dis osal Field: Distance from nearest well_-..��._____.Distance from foundation____ _______________Distance to nearestlot line____I_.________ IR Number of lines_-{:__--_---_- - � Length of each line_______ � --......Width of trench--------- p-_f_ -------------- TYPe of filter material---- _PCA of filter materia _._ __�___ -----.Total length---------- -----------•-- Seepageline qL . Pit: Distance to neatest well-__-_________________Distance from foundation________--__--.-___.Distance to nearest lot line__.______________ ❑ Number of pits----------------------Lining material----------.------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: ----------_-------- ------Cesspool: Distance-,from nearest-well-----------------Distance from foundation---------------_`.__.Lining material-------------------------------------- El Size: Diameter---------- -- --- ------.Depth---------------------------------- -------- ------Liquid Capacity---------------------- ---gals. Privy: Distance from nearest :well----------------ri-------------------------------Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line ---------------------------------------------------------- ------------------------------------------------- --------- Remodelingand/or repairing (describe)------------------------------------------------------------------------------------------ -----•--------•-------------------------------- -... -----------•-------------------•--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------- ------ s_, ------------------------------------- --------------------------------------------- ---------------- - - ---------------------------------------------------- - - - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)'`� t -G1Q-- N�----------- ------- -------------------------------------(Owner and/or Contractor) fO BY: L.. - - --- --- --------------(Title)-------------------- (Plot plan, showing size of lot, location of system ' r ion to wells, buildings, etc., can be placed on reverse side). D PARTMENT USE ONLY APPLICATION ACCEPTED BY-------- -- --- ---------------------------------------- DATE--------- =-.11-' REVIEWEDBY--------------------------------- -------- DATE---------------------------- BUILDINGPERMIT,ISSUED--------------•--------•-------------- --- - ----------------- DATE------------------------------------------------------------ Alterations and/or recommendations:------------------ ------- -- ---- --- --- --------------------------------------------------••--------------.----- -----------•------------ --••------- --- ----------------------------- ------------------------------------------------------------------•--------------------------. - ----------- •---------------- ------------------•--------------------- -------------- -- --- -- ---------- ------- -- - -- -•--------------------- ------- ------ -------------- 4 -----------------------------------------------------------------------------2NJ ------------------------------------------------------------------------------------------------------------------------------------ �3FINAL INSPECTION BY:-- ---------------- Date- ------ -- -- --SAQUIN LOCAL HEALTH DISTRICT 1401 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California F.PXG.