SU0010009 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. ...1.. � .- (Complete-in Duplicate) Date Issued --- Z.SS- 3 i0 -2.3 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. 437VQ S" R19k;F.J 33 I JOB ADDRESS AND CATION-Ce,a ...w �f�/_ �. .X7t'� !' /x / - . i..r------ _.-.........• -- Owner's Name ...... --• �aL%�� !p.'tR� .............................. -•-------------- - ----------------........ Phone..._...--------------`. .-•-.. Address....... 'P�--`--...-(. v!------ 1 _ ._�... - .e_.... .......-_-- - Y........- --- .._._............._......_.-..._....._... Contractor's Name........ . ......... - ........................ ........................................... phone................`....._...... - Installation will serve: Residence Apartment House ❑�/Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ....... Number of bedrooms _"r.. Number of baths .._ --- Lot size _ ..1V.......�......Q...... Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table U f+. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loom ❑ Clay Loam ❑ Clay Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No 9 New Construction: Yes No ❑ FHA/VA: Yes ❑ No�' TYPE OF INSTALLATION AND SPECIFICATIONS: �2fee �( (No septic tank or cesspool permitted if public sewer is available within 200 feet.) v7J��`a� Septic Tank: Distance from nearest well...�y..Distance from foundation._.:/.1?.......Matenal ...�'. . !g.t-p .. CA o. of compartments-_..Z+_.__�...ISize...3- _e_'_A_:4iquid depth.... .1...�/...Capacity.....��:�.. Disposal Field: Distance from nearest well _570. from foundation...��! .. ...Distance to nearest lotte-_5�... �ber of lines.............. 7.Length of each line......��r� �r....Width of trench.. . ..__��_............. of filter material._"T __h_ Dep+h of filter material..... longth....... Y2�_...__..___..... ..., 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.............._...............-.R ❑ Size: Diameter.......----..........................Depth------........... ------......-----..------.....Liquid Capacity..-............._-----.gals. Privy: Distance from nearest well____----------------------------------------.....Distance from nearest building..._..---......._....._,____.___---- ❑ Distance to nearest lot line......................... - ---. . .......................`................•---- ..................................------ V Remodeling and/pr repairing (describe):_........ T �C __�/7 r �- -'-` rJ-=-- ---..r.Q::- ... - _. pts ..t ....1. ,f....t..r._. - - ---_-- :2 �cr}u r----•-•• .--- ...................................................... ------. -------.................................................. - --...---------------------------------------------K-------------- ......_..-----...........................................................................................----.._... I hereby certify that 1 have prepared +his application and +he+ the work will be done in accordance with San Joaquin County ordinances, �Stta�te laws, and rules and regulations-of the San Joaquin Local Health District. s+ - ;✓ (Signed). ...../.... i ................................------ ............................................ - --(Owner and/or Contractor By:.............-/------------......-------------........--..._.-- ----------------------------•.----------------------..(Title)_----------------.......... ..... - -- (Plot plan, showing sae of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- - - - -- - ... - DATE... ..................................................... REVIEWED BY------------------ --------- ... - - - DATE .....:... BUILDING PERMIT ISSUED.- C .v------------------....................... DATE--.....Z_M_ Alterations and/or recommendations:.-_.............................................. . ----------------- ._....._......-----------------....-................. ..._...--- \ - -------------------------------------- •--------------- •------------------..-,....-••-•-•----- ------------------•-----------,--,_,-.-..-._....-._......----- ---------•---- / ----------..........-........................................... ................... - ------------------------------.............---------- ---------•---.......................................... - ..............................................- -..... - - --•---------------....-------------•----------•---------------------------------------------------- FINAL INSPECTION BY ...... ..... .............. [ ! - `.. Date__...,"�..... � •� �..................-- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American S+me# 300 Wast Oak stmt 132 sycomere Street 814 North "C" Sfroet Stxkion, California Lodi, California Manteca, California Tracy, California FS-9-2M Revised 1.57 F.P.CO.