SU0003451 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: t _ --------- At, ,CATION FOR SANITATION PERI Ief Permit No. S"- t (Complete in Duplicate) --- - _----------- -- --"-_ Da+e Issued This Permit Expires 1 Year From 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. / ------- ----------------JOB ADDRESS AND LOCATION--------- —e16.-A --=-- --------- l -� I // 1' � �--------- ----- - Owner's Name--------- --•--------- ------------------------------------------- ------------------------------------------- Phane-.. Address............ ...8.0-A---------- •-•---+ 5- A -c / --------------------------------- -------------------•-----------•---------•-----------•- /" / Contractors Name.---__ice__-1q-/1-�i /e---- �?.N:.0 � " ' '�%�PGr Installation will serve: Residence 0 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ i Number of living units: -/----- Number of bedrooms -1---- Number of baths _/---- Lot size ---...".✓__tae— + j - ------------------- Water Supply: Public system ❑ Community system ❑ Private N Depth to Water Table .47-&t. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sa `Loam [1Q Clay Loam ❑ Clay ❑ Adobe ❑ Hard nj] Previous Application Made: {If yes,date-.--------- _--_-) No New Construction: Yes No E] FHA/VA: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 240 feet.) r I Septic ank: Distance from nearest well_-_t�Q-___-Distance from foundation---14----------Materi ---_ Y .il_ .__--------------/ r' No, of compartments-------�-------------Size-3.k- ---Y—'-Liquid depth_ - .------Capacity-- 4" EI _ Disposal F' d: Distance from nearest weIL Q----.-Distance from foundation--�-/-6"--_.._-_ istance to nearest lot line--__ .--- Number of lines------------- r �s �,"_"--.---."------Length of each line_/��l}---.�-�.�O'_.S/Vidth of trench. P�-'�-l"__________________ Type of filter material------PG-al�_--_-_Depth of filter material-_--�_- -- ---------- length___.-...-SS�Q________________________ t i � r Seepage Pit: Distance to nearest well_-/-01---------Distance from foundation---_/11-._____-..Distance to arest lot line--C ----_----- e , n x " { lrs��c',4 V' ❑ Number of pits-------I-------------Lining material----Rd-e ff---Size: Diameters Altd------?Up ------- ----•---------- Cesspool: Distance from nearest well-----------------Distance from foundation------------.-------Lining material_----------._-_.-.-------_--------_-- ❑ Size: Diameter--------------------------- -------_-.Depth_--_""""-""-___----------------------------- _"___."Liquid, Capacity...-----------------______gas. Privy: Distance from nearest well------------------------------------------------- from nearest building----------.-.--_-__---___----_.----_--.-: ❑ Distance to nearest lot line---------------------------------- -------------------------------...------------------------------------------------------------------------ Remodeling and/or repairing (describe)--------------------- -----------------------------•---------------------....-----4 ------------•--------------------...-------------------------- ---------- --------- ��41� -------L-AIA—e_----- �!' '.c I_ f� ' "�------ ----- - --•---------------------------------------------------•- ---•------------------------- ------------- ----- - - - -----------------------------------------------------------------------------------------•-------------------------------------- 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 Sawn Joaquin Local Health District. Sined U'�9/_ - e.[SI_C*F- - E'---- �-/ --.�C-----� ----------------------------------(Owner and/or Contractor) I g ) /� � BY G<C.l�_ - .." ---------------------------------- ----------------------------------------------(Title)--- E'v�• �'f �` (Plot plan, showing size of to ocation of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY # APPLICATION ACCEPTED DATE. �-- J � - ----------------------------- REVIEWEDBY--------------------------------------------- ---- ---------------------------- ------------------------------------------ DATE-------••-•-------------- ------------------------------- BUILDINGPERMIT ISSUED-------------------------------------------------------------------------------------•--••----------- DATE----------------•------------------------------------------- Alterationsand/or recommendations--------------- ---------------------------------------•---------------•--"----------------------••----•----..-...---------..._..------------------------------ -------"-•-------------------•----------------------•----------------- ----------- -------- --------------------------------------------------------•----------------------------•------------------------------------------- ----•------------------------------------- ------------ -----------------•------ -------------------------------------------------------------------- ------------------------------------------------- ------------ --------•---•-------------•-"--•--------------------- ------------- - - -- -- ------------- - --- ----- ------ - -------••-------- ---•-------- ----------------------------- FINAL INSPECT N B ' :. Date---------------- �---l .y�------------------------••- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:eltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-S9 3M 3-'63 F.P.CD.