SU0013453 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ............... . ............. ....... . (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 it County Ordinance No. 549. b - -- JOB ADDRESS AND LOCATION._. 4.I,P..T..rr_ cl... Owner's Name- f��—'�. �T'-G/4.e, f 5 ................................... .. _ ..._.................................. Phone.................................... Address..../.?T-- 3 .- ';d!/X..---/. r/l.....................•------------------........... ...... Contractor's Name O.IS'1Y�../.-�;e..,S../.0,11 a-,V.N...e..ty.....e P . . .... ...................................... Phone-3b,17.1.1-71.6 Installation will serve: Residence [1}' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ../..... Number of bedrooms ..+Zt... Number of baths. ..... Lot size ..... /IGRAG-/= Water Supply: Public system [l} Community system ❑ Private ❑ Deptn to Water Table .-. -- - ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loom ❑ Clay Loam P�'Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Mede: (If yes,ciote._ _ -._.... ... ) No ❑ New Construction: Yes P? No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) - — �' i _ � ,p U Septic Tank: Dism tance fronearesT well..- Q Distance from foundarion . .D........ Material .. -------- [� No. of compartments.._ ..7'-we ...Size [ 0.0...........L:quid dep.tn . ....6.A1.0 Capacity...................... . . Disposal Field: Distance from nearest well...7Q1------Distance from foundation..#P" ... Distance to nearest lot line................. ❑ Number of lines ......T/VO..... _... Length of each line....../Oe.............Widt;n of trent:n.....�.'r........................ _Depth of fitter material.... th....... Total len ZZ . ......................... Type of filter marenal...I-,lZ............ g Seepage Pit: Distance to nearost well _.--: 0... .....Distance from d fourdation.../..Od•!..--..Distance to nearest lot line................. F-1 Number of pits---74"._...Lining material.h:.li AP&/ S'ze: Diameter. jj#$� Depth.. ............... Cesspool: Distance from nearest well ................Distance from toundat'on._ . Lining material.. ..... Z ❑ Size: Diameter. -- . ----....... ....... .. .Depth .... .. .. ..........................-- ----.Liquid Capacity. ------------------------gals. Privy: Distance from nearest well...... .............__--.......................Distance from nearest building ..... __.......__.._._______ ❑ Distance to nearest lot line ...._ ........ 1....................................................... ........................................eo . Remodeling and/or repairing (de tribe): ... %. . . .. __.................... .............. ...//. .... -----------------------------------------------------------------------------------------......----.. ....................-.................... _... . ... -- -- --- ------ ---------- - - - - - - - ....... . .....--_......................... ---- . ----------.------ -- ------....----......-----•------. --------- ---- 1 her certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinance ate (a and rylP� and ulations of the San Joaquin Local Health District. (Signed. N......... __.......... _......... ........... . .. .....(Owner and/or Contractor) _.. .(Title) ....,_O w,.• -- - - -. (Plot pan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). / FOR DEPARTMENT USE ONLY Al APPLICATION ACCEPTED BY . : . .. ._........_..._......7 � - V � . REVIEWEDBY..............................................__......................... . DATE_............... ............... ......................... . BUILDING PERMIT ISSUED...................... . . . ......... .. / DYE .... .................... ......................... .. ...... ....... !� --- Alterations and/or recommendations:_._.—I.. ------- .----..._.�_--- -- ... ---------- --- .•._ ---------------•-_---•-_ ................. . _ ._. t .................................................................. ... .....................------- . ....... ...... . ......_...... .. ......................................---..... ..----------------.......... ...................................................I................_ .. ...........................-- -----.......................................... .............._...... ............._......------------..._....... ..... ............................................. FINAL INSPECTION BY:6 __._. Date---..-�"�.~ V- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Masellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi California Manteca,California Tracy,California E.H.9 2M 1.67 Vanguard Press