SU0003874 - Laserfiche WebLink

Home Browse Search

I VIS VI I I\..L V11: ---------------------------- ----------------------- ---- _...... -._ ------ APPLICATION FOR SANITATION PERMIT Permit No. 2 (Complete•,in,Duplicate) Date Issued .....-._ This Permit Expires 1' Year From Date Issued Application is hereby made to the San Joaquin,.., cal Health District for a permit to construct and install the work herein desbribecl. This application is made in compliance with Q-i&u ty Ordinance No. 549. JOB ADDRESS AND O IONV... _--."�97ii� _i/LG __Owl � ---------- ---- -d -u ! --c ----------- ` •. 01, Owner's Name._ � � _ .. ------------------------------- --------------- ---------------------------------------------------- Phone- Address__- ...... �p Contractor's Name_��_:- ------------ ----------------------------------------------•-•-------------------- Phone Installation will serve: Residence 4 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __t----- Number of bedrooms __ . Number of baths.._l._ Lot size _---e---__..__-..._--_--_-_.____-- Water Supply: Public system ❑ Community system ❑ Private P Depth to Water Table &. ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam Df` Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date- ) No M New Construction: Yes ❑ No ($ FHA/VA: Yes ❑ No 0 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_J.a-_--__Distance from foundation---1Q........,-.Material ------------------- 1524 __ ________•-.-___-.© No. of compartments__-__--2---------------Size.___Zeno_---------m...Liquid depth_..=i :_'..........Capacity.-96Q__.--__-- Disposal Field: Distance from nearest welQ_4........Distance from foundation-__/ .......Distance to nearest lot line---,- .... Is Number of lines.._......_..P'. ............ . Length of each line_.. .._ d' Width of trench----AY N_.----------------- Type of filter material___ 6 `..._Depth of filter material----/_4`7---------Total length......6�5 _______________________ Seepage Pit: Distance to nearest well......................Distance from foundation_______•____-_____--Distance to nearest lot line__-______----__-_ ❑ Number of pits.....................Lining material----------------------Size: Diameter---------------_------Depth__=:_., z------.•.---------- Cesspool: Distance from nearest well___•-____-•--.•_Distance from foundation----------------- --Lining material----------- ` . s t__________________. ❑ Size: Diameter -- -------•------ -----_-•-------Depth----------------------------------------------------Liquid Capacity------------- ------._.gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_-___________-_.-___-_____-...._ ❑ Distance to nearest lot line---- --------------------------------------------------------------------------------------------------------------------------------- ----------------------------------•--------------- ------------••-------------- .... r ' Remodeling and/or repairing (describe):---P_.-�al2.__-_�..��z? _- ---- .____ ---------------------------- ------------------------------------------- ___________________________------------------------•--------------------•----------------------------------------------------------------------------------------------------------•-----•-----•---•-----•------------•--•------------------------ ---•-•------------------•----•--•-------------•--------------------------------------------"------------------------------------------------------------------------------------•-- - - ------------•-----------•-----•-•------------------•--------------------•----------------------•----•--------------•---------------•--------------------- --------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Coun ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)_ . _._ -. -__-.- � __...._ ___.__ �( wner and/or Contractor) ` -------- --------•--------------------- --- By: ��, _:-.:. ts .--- .... - ---------------------------------- (Title) -------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 6 _.. - - ---- --------------------- DATE........2._1.9--------------------------------------- REVIEWED /.Sa------------------------------- REVIEWEDBY - DATE-----"----------------------------------------------------- BUILDINGPERMIT ISSUE - ------- -------------------------- ----------------•------------------------------------------- Alterationsand/or recommendations:------------------------------------------------------------------------------------------------------------------------------------------------------------- ------.-•-------------------•----------------•-------------------------------------------- ------------ _•-__.__._._?----."......................•--.-__._-.-_-..-...---.___:_-...--..__.-..--.--_...---..-..-__--.._---__-__-____-____ --------------------------------------------------------------.___.__ _... ._ FINAL INSPECTI BY:... Date---------------- ._ _-----:---------------------------------------------- JO UIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. ..300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi. California Manteca,California Tracy, California