SU-2601274_SSNL - Laserfiche WebLink

Home Browse Search

i vn vrnt C UJr --_ --- . -- �sr - -. APPLICATION FOR SANITATION PERMIT Permit No. ? (Conlpfete in Duplicate) "-"""••• -- ...'---------- -- This Permit Ex ires 1 Year From Date Issued �•--' Date Issued Application is hereby made to the San Joaquin Local Health District for a permit t str ct Ininstall the work herein described. This application is made in compliance with County Ordinance No. 549. + y 33.sR .U. �N�. ,� /`� �rI /Vs- 2-Y0-y JOB ADDRESS AND LO .4 ,bpi @St~ 3 . g F_AU...a.. Owner's Name------- /4- rl Phone. ' ¢ Address...... : ....... _.. - ,5 - --- ------ Contractors - Name --- - __ Phone-_' b.d`�?..49 7 Installation will serve: Residence El House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other f�r Number of living units: -1_._. Number of bedrooms Z_ Number of baths T..._ Lot size ._l0_ Water Supply: Public system ❑ Communit s Y Y stem ❑ Priva to Depth to Water Table,ll��ft. Character of soil to a depth of 3 feet: Send [I Gravel ❑ Sandy Loam❑ Clay Loam Clay I] Adobe❑ Hardpan ❑ Previous Application Made: (If yes,dote ___ __._) No New Construction; Yes No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_; ft.___Distance from ---- Material_.__. _ No, of compartments-__., "` ------- jr'A Size Liquid depth- 2_rr Ca aci r P tY-- -Q�_ ---- Disposal Field: Distance from nearest well..200--Distance from foundation.._ pry .�....J... ___..Distance to nearest lot line.1-0__-- 'F' Number of lines___._ C/ Length of each line----' E1_1-_-, Wid+h of trench_._, :��----:-__- W Type of filter material- Yt YP �._.Depth of fiite� material...:.....1.9-____--Total length..........47Q•.............. �Seepage Pit: Distance to nearest well--ZO,Q•.....Distance romkludation-_. __ +."�' ---..Distance to nearest lotNumber of pits.-.O7 ,�-6)Lining material_ cf- .Size: Diameter---.3_3..-----. Depth. -�'..---••-- Cesspooh,.' Distance from nearest well_..._::._._. Distance from foundation ...____-- -- + Lining material ........................... ❑ Size: Diameter_.:..........................-' Depth - - - --..Li uid Ca aci - N I' t - - -----.... - q Capacity! •------------ ----------gals. Privy: Distance from nearest well......' ......._Distance from nearest.building----'-.El _--.-_-- Distance to nearest lot I ne..... ....::.. . _... ........ Remodeling and/or repairing (describe):. ......_ ------------ -------•-----•-•--••--------------------------------- ------ -------- . l =" ------------•......... ....... . ....... . ... . hereby certify that'llThhavep d this application and +hat tht3'wark ri be done'ifi accordance with San Joaquin County ordinances, Sfate laws, angulations of + San Joaquin local e h District. (Signed)-- --------- ------ ......... .... . ...(Ownerand/or Contractor) By---- -------------••---- 1 e ------ . ..( )(Plot plan, showing size of lot, to n of system in relation f ells, buildings, etc., can be place on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY , 7� :_...- --------- ------ DATE..... . ---- •--. .- ------------- ---------- - REVIEWED BY.,................. ------. ........ ----- - ----- --- --- �"-- ---�-----" --•----- . .. "----- DATE_..._._................................. BUILDING PERMIT ISSUED...................................................._ . ------.....---- -............. DATE_....."---------------I................. .................. Iterations end or recom .endations:.. ...__.. -f6 /�% - -- -- ------------------------�'.. � ` ' ' FINAL INSPECTION BY: - ------ - -----...-"----- -- ---- Date --. �`.--��_..._...... SAN JOAQUIN LOCAL HEALTH DISTRICT u 1601 E.Naselten Ave. 300 West Oak Street 124 Sycamore Street 205 West 9eh Street Stockton,California Lodi,California Manteca,California Y,acv,Callfornio F�P.Cf7.