SU0011390 - Laserfiche WebLink

Home Browse Search

" OR OFFICE USE: 3U ......................... - APPLICATION FOR SANITATION PERMIT Permit No. . a�. ' ¢'e►Y•• (Complete in Duplicate) y _ - ...........-........................ This Permit Expires 1 Year From Date Issued Date Issued O 8`C-O'zo-sz_ Application is hereby made to the Sen Joaquin Local Health District for a permit to construct and instalkthe wor, herein described. This application is made ' -compliance with County Ordinance No. S49. FrfST s/.Dc CDP Peau A4A"e JOB ADDRESS AND LOCATION...RT--3�.. X.�ZSj..... To�s'CI '_ l r Owner's Name........12.�j(N 40A.V4............................................. ....................................... --------- Phone.................-._............... Address.......-..... a✓ Contractor's Name..M_u.A!LE4RT---.. :!/G/�AEir- ----- {-Pt---- °�' - _ 4. ltl...... Phone_36. '.-S66p- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other �( Number of living units:tnm.. Number of bedrooms ._—.. Number of baths . Lot size ....AR q................_..-_......- Water Supply: Public system ❑ Community system ❑ Private X Depth to Wafer Table ........ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ja Clay ❑ Adobe❑ Hardpan❑ Previous Application Made: (if yes,date....................) No New Construction: Yes D[ No ❑ FNA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-/ FT..-Distance fromfoundation..3.Q...FX.Madterial....�ti{„rQ,�TT�;:.__.. I\ No. of compartments .............Size...I? :.-A.24A trLiquid depth....... . .....,.Capacity... C!-$ $ Disposal Field: Distance from nearest well./P..o_PI.:Distance from foundation.....'V1..AXDistance to nearest lot line................. Number of lines...... ...........................Length of each line..._...010---- j......Widfh of trench.... 'v !/...... Type of filter materiel. -:�-� --Depth of filter material..../.9.r_.......Total length......... . Seepage Pit: Distance to nearest well.. ..rf 2.00 rDistance from foundation... .. .... -� � tt �� ..Distance rto nearest lot line..--.-....... [� Number of pits._...I.............Lining materiakV__.R6rf�..Size: Diameter_._.-+�a3.......Depth.__..�.sr.�.....__......._ i Cesspool: Distance from nearest wel.................Distance from foundation....................Lining material............................ Size: Diameter......................................Depth................................------_-----'....Liquid Capacity...........................gals. Privy: Distance from nearest well.................................................Distance from nearest building❑ .......... ----- -- Distance to nearest lot line.--------------- -------- Remodeling and/or repairing (describe:-----T7144.45.........,1.5-----------=--$�'P-r1G........ r ..._...�.yD-------a -------Irl.4%VA.-- +8i4sJ,�..__.../��.....-•-4----•!tet-�2 / tQll../.JP HCM..._......8111 L.&I.Ael.--------------------------------------•------- .............................. ............................................-----.........................-............... - ---- ......-------- -------------------....._. -.....-------- ..... I lhereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County I ordinaf aces, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) -v/f � r----..fir. :f�C.I�. jam----Pi.P.q-:..--C2'................- -------------------.(Owner and/or Contractor) f_Br....... /- . --------------------------------......-----------------------._(r+Ie) - .lZ t'- ..... ..... _.. Plot plan, showing size of lot, location of system in rely+ion to wells, buildings, efc., can be placed on reverse side). FOR DEP TMENT USE ONLY APPLICATION ACCEPTED BY--------- O OC...----...................................... DATE--- 1.... ...f6T...... - REVIEWEDBY......................... ......................--------------------------_....----........_._..............._.. DATE.---- ... - -..... ._.......... BUILDING PERMIT ISSUED....................... .... ..Alferafions and/or recommendations ..... ---------........----....---------•---------- ----......................- ---------------•----------------...... ------. ............................... •------. ................ ....................................._.........................----.--..------....:--•-------• ------------------------------....------........_...-----...........................---............... t ...................... .....I.......................................................................... •-----....._..-- -------- ------------.----------................._................-----------........... FINAL INSPECTION BY:.........F. ....... � rt�� Date...... Y_ % - -- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.HoWton Are. 300 West Oak Street 174 Sycamore Street 205 West 9th Street Stockton,Callfornla Lodi,California Manteca,California Tracy,California