SU0007926 SSNL - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: A ICATION FOR SANITATION P . fERPermit No. --.-:'f�-- (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. 3 t©q 'ins 3 ~ZS' JOB ADDRESS AN� LOCATION ".� .1u` %.•_fT '-%;� Ljy -•- -`� =-L_`�a3.-,__:= -t�l.y:-... /r OwnersName} ---- --------------- ---1:.------------------------------- -- ---- Phone---------------------.-. --•-------- Address . ..- . -1, ---- ' ..Le.. %µ.=� -------------------------------- --------------..--_----- Contractor's Name............----------_--------..-------------------------------------- - - ----- ------ ---------- •--- Phone------ -----------------••-•------- Installation will serve: Residence [ /Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ...!,_- Number of bedrooms _- Number of baths ../..-- Lot size ---- 1-''_______________-__...-_ Water Supply: Public system ❑ Community system ❑ Private ❑ 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.................. I No ❑ New Construction: Yes ❑ No ❑ FHA/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-----------------Distance from foundation--.-----------------Material__.....-_..----...--.---------_-......._....... ❑ No. of compartments- ------------------Size--------- ---------------------Liquid depth---- ------ -_----_---Capacity-••------------------ Disposal Field: Distance from nearest we11.................Distance from foundation------------------. Distance to nearest lot line----------------- El Number of lines------------------------............Length of each line..............................Width of trench--------------.-----------.......... Type of filter material-------------------------Depth of filter material......------.------.---Total length.-__..---.---------_-.___---_-_----_ w Seepage Pit: Distance to nearest well...- Distance from foundation_._-.1-/9------- Distance to nearest lot line._-�_- -� Number of pits_._../---------------Lining material---`-Ile---...--Size: Diameter....-- Depth......' L�---------------- C3 Cesspool: Distance from nearest well-----------------Distance from foundation......------ --.__ Lining material------------------------------------- El -.-._....-- _.___.-..-.--.----.-.-.❑ Size. Diameter----------------- :- - -------Depth---- ------------------ .........................Liquid Capacity.. ---------------......_._gals. rn Privy: Distance from nearest well ................................................Distance from nearest building------------------------------------- ----- ❑ Distance to nearest lot line------------------------- -- --- - ---------------------------------------- --------------------------------------------------------- 0 O - Remodeling and/or repairing (describe(:--- - � - .. > _.. _.. -•::'_=-------•------------------------- h -------------------------------------------•------------------ ----- 3 ----- --------------------------------------------- ---••--------------------------- ----------- - -------------------- ............ - --------------------------- -------- ----------------------------------------------------------------------------------- ------------------------------------------------------ ----- ...-------- 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. w nd or Contractor J i (Signed)_----------- ------------ - ... ` By:. ------------------•--------------------- ------- t' --- (Title)----------- .................................... ... (Plot plan, showing size of lot, location of system in relation to wells, buildiri s, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTEDBY_./. :_.•-:.=:_ �r„f. -- REVIEWED BY ----------------- - ------- . -----.----- --...-..........._.... . --- ------------ ---------------- DATE......... . ........... ................ . .......... ..- BUILDINGPERMIT ISSUED------------- -------... - ------ ------------------------- --....................._ _ - - -.- . DATE--- -------- ----------------. Alterationsand/or recommendations:- ------------ - --------- ---------- -------------------------------------------------------------------------------• - - --- -• - --•--- ......... ................... ----- ............... ---- -- -- ---------- -- ........ ------------ .- --- ---------------- -------- -- -------------------- ------------------------------------- FINALINSPECTION BY:./,/.,.-------------- --------'---. ........... .... Date....----.�- -- ------ ........... ...-......... ........ SAN JOAQUIN LOCAL HEALTH DISTRICT 7601 IF. Hasalfon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,Catifornic- Lodi, California- Manteca, California_ Tracy,California_-- ES 9 REVISED B-59 314 3-'r.3 F.P.CO.