SR0081495 SSNL - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. 1. ...... ...................... . . .•'•-•----- •Y ... �y{ r1 ..--.... (Complete in Duplicate) r �..�.V./...__...... . This Permit Expires 1 Year From Date Issued Date Issued 1��L2.�:. 5+ 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 . . -�. .6 JOB ADDRESS AND LOCATI N_...o?: r/.f'i�*.:1:•�._.lYl''.-- - "� ---�'-'2......L. .... ...............�....... .. . _7� Owner's Name.—_., p .. . ...... .............. .. ................ ...................._... .... Phone I r- 4 . Address-.. _.1 ��. . �.`}...............�TE._- /...-.Box....3�4.......�'ITGI}... ........................... ...._.-............. ------ - _ . .. ....... ..._. .. ....._...... Phone_._......__._..-. t Contractors Name..... - -� �f Installation will serve: -'Residence It-Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --- Number of bedrooms-3... Number of baths Lot size .... ..._.... Water Supply: Public system ❑ $'Community system ❑ Private [-AlDbpth to Water Table .4 h Character of soil to a depth of 3 feet: Sand [] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Of yes,date. 1 No E)' New Construction: Yes ❑ No [ FHA/VA: Yes ❑ No ❑—t TYPE OF INSTALLATION AND SPECIFICATIONS: v ( o sopftc tank or cesspool permitted if public sewer is available within 200 feet.) _ w Sept] eyk; Distance from nearest well.................Distance from foundation..... ...........Material......... . filo. of compartments....................`.-_Size-----------............. .....Liquid depth------.. Capacity................. ... Disko F �i Distance from nearest well..%-r .. ......Distance from foundation....AZ"..........Distance to nearest lot line_. ......._ Number of lines......4 .. .. ......._ .......Length of each ' Wicth of trenc.n......3 �.,... �.. Type ci filter material.?oL�S............Depth of filter ma erial '..2Q_...+otal length . . .?....... Seepage Pit: Distance to nearest well_____...............Distance from foundation ............... 'Distance to nearost lot line................. ❑ Number of pits .. ... .......Lining material.......................Size: Diameter.._ .` ..... .._Depth..............._................ N %, Cesspool: Distance f.-o-n nearest well.................Distarce from fougdation ........ Lining material ... .............. ._........ ❑ Size: Diameter....... . .. ...................Death..... ........_................ . Liquid Capacity._ ......... . ...gals. , Privy: Distance from*nearest.,well.. ....,............, ......_............D'stance from nearest building.. ❑ Distance to nearest lot iine... ............................ .............................W............__.......N.1-------------- _. _........ .. Remodeling and/or repairinq (descri'oe)%.r............. . r .......... . '- . ................ ............._....... .....--•---•-•-----...........-----..._.___.............-----•••--•......-------•-•-••.............. . .. ».»...._...».. � k. .• - -_......_ _ _.............•••----....----•-•..... .. _.........._.......__...._.._................_.... .-•-•-•-- ................................... .. r 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 r Pes qnd regulativns�`4 the San oaquin Local Health District. C,/ 1 (Signed)------- _..-...`.....-- - .--- ---- -- --- - .... ...... ............... .......... _ . . (Owner and/or Contractor) l By: .....(Title). (Plot-plan,,-showing size.ofrlot, location-of-system in.relation to wells, buildings,--etc., can be placed on.reverse side) .— FOR DEPARTMENT USE ONLY — APPLICATION ACCEPTED BY......�Tr. ..rO-•- ........... .._..._.......-•--.................... _ DATE......LP.-zS-bS�.................... REVIEWEDBY........ . ...................._. ...... ...... .. ......................................... ......... DATE. ...... ..._ ............ ......................... BUILDINGPERMIT ISSUED.. -- ................. ......_....---.... .. ............--------.................. ..... DATE................ ................._..................... Alterations and/or recommendations;.......»...-. .................................. ..... .................................._........... �._....._..........._.......... t..., i.. ._........ ._......_........_.... .. .......»............... s'f :t 1 ♦>t's ................. . _.. _..............................__....--... .. .......................................-................... .......:._:.....................»».......»...................................... - --................ . . . .................. ._. . . ............... ....... •. .. .. ..------......_...................._..._........................_............_......... FfNAL INSPECTION ! /�`� ........ _ ... - ' ' Datc } SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hoaelfon Ave. 300 West Oak Street 124 Sycamore Street 205 West 01h Street Stockton,California Lodi,Callfornia Manteca,Colifornia Tracy, Calitornla r.P.CO.