SU0003875 SSNL - Laserfiche WebLink

Home Browse Search

1-UK VrrIC t U5t_. _ n .- - -------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ___.�.7I1.:3_... (Complete in Duplicate) This Permit Ex ires 1 Year From Date Issued Date Issued __ yl� ,�_� Application is hereby made to the San Joaquin Local Health District for a permit to construct and install th r herein es n ed. This application is made in compliance with County Ordinance No. 549. r�f ` JOB ADDRESS AND LOCATION. � Qil -_�rh4t ' , 'f�iJ � '� �L{y -------•----- Owner's Nam,ee I 2,0.6 -y/!/ - -----•--------------------- -------- --- ---------------------- ------ Phone------------------------------------ Address-------- --------------•--------------------Address-------- 16-p'?e --------- Contractor's Name_-------_X,r_PrA e- -------------------------------------------------------- -----• Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial 0 Trailer Court ❑ Motel El Other Number of living units: - -- Number of bedrooms__ Number of baths r__-_ Lot size1aewo--- ________________________________ r Water Supply: Public system ❑ Community system ❑ Private V-'Spth to Water Tableft_ Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam ElClay Loam Clay ❑ Adobe ❑ Hardpan ❑ f Previous Application Made: {If yes date__---- -------------} No ;K New Construction: Yes gillNo ❑ FHA/VA: Yes,�No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 244 feet.) , Septic Ta Distance from nearest )y -- --__Distance from f u dation_Ai' _ ial_ _- ___.Mater _� _ee i` No. of compartments ---------------------Size --____-- -- _ _ �eid dei?th_-.- --------------------Capacity/ � _-- Disposal Field: Distance from nearest well. _____.Distance from founds •on--f _____Distance to nearest to line_ _-__ wo, Number of lines--.,----------- _Length of each line_ ________ ----------Width of trench Type of filter materiall ge,e--Depth of filter material_��__-__---__Total length__"- �__________________________ i - Seepage Pit: Distance to nearest well----------------------Distance from, foundation----.---------..___.Distance to nearest lot line_____-________-__ ❑ Number of pits______________________Lining material-----------------------Size: Diameter----------------------.Depth----...-------------------------- �. Cesspool: Distance from nearest well__---------------Distance from foundation--------------------Lining material-------------------------------------- 0 Size: Diameter--------------------------------------Depth--------------------------------------------------- Liquid Capacity----------------------------gals. Priv Distance from nearest well --------------------Distance from nearest building--------_----------------------------_-_-. ❑ Distance to nearest lot line-------- --------------------------------------------------- y. Remodeling and/or repairing (describe):-:-- --------------------------------------------------------------------------------------------------------- ----------------------- ----- -----------------------------------------------•-----------------------------------------•--------------------------------------- -------••--•------------------------------------------------------------------------- ------------------------- --------------------------------------------------------------------- ---------------------------•--------------------------------------------------------------- - - - I hereby certify that I have preparekd.this.-application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules a d regulations of fhe San Joaquin Local Health District. (Signed) Contractor By:------------------------------------------------------------------ --. -(Title)- -- -- -= ..--.-- - ---- (Plot plan, showing size of lot, location of system in relatio wells, buildings, etc., can be p ced on reverse side). } FOP, p ARTMENT USE ONLY APPLICATION ACCEPTED BY----- ------------ ------------------------------------- --------------------- DATE---------_------------- REVIEWED BY = DATE ?----- ------------------------------------------------------- - ------------ ------------------ BUILDING PERMIT ISSUED--------------------------------------- •----------------------—-------------------- - -- DATE ------------------------------------------------------ FF Alterations and/or recommendations---------------------- •------------------------ -------------------- I- ------ -----------------------•---------------• --------------------------------------- - ------------------------------ ------1--------------------------------------------- ------------------------------------------------------------------------------------------------••-------------------------------------------------------- -------------------------•--------------------------------------- -- - - - - - - - ------------ --- - ------------------------ ............. :----- ------�_ - ------------------------------ --------- _:------- --------------- - --------------------------------- ------------------------------------------------------------- -------------------------------- tFINAL INSPECTION BY-------------------- --_ `-------r--------- `---"= . Date--------------- --------------------------- ------------------------- ---------- F I r" SAN-JOAQUIN LOCAL HEALTH DISTRICT C1601 E.Hazelton Ave. 800 West Oak Street 124 Sycamore Street 205West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California