SU0010313 SSNL - Laserfiche WebLink

Home Browse Search

AOR OFFICE USE: ..........:................ ................. 491 _................_................._............... . APPLICATION FOR SANITATION PERMIT Permit No. ...lr� �. a .------->........................................... (Complete in Duplicate) This Permit Expires t Year From Date issued Dote issued ----------� application is hereby n4ade to the San Joaquin Local Health District for a permit to construct and install .., a work herein described. This application is made in compliance with County Ordinance o. 549. oQ JOB ADDRESS ANDyLOCATiO y .• � �.: ........01viel—8 h�� :.;5� ..... j Owner's Name.......1�' - Tc .cQ- - ......................_........ Phone...... Address._.__. .-.�- _ ------ - --------------------•--------------------- •------•----••----- Phone.- 'Contractor's Name •-� .�. i � 1 Installa+ion will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Nei ❑ Other ❑ J- Number of bedrooms .-/_. Number of baths __.rl.;L e _-, Number of living units:i-.__. Water Supply: Public systems❑ Community system ❑ Private, Depth to Wate\1 T ._.__._. ft. Character of soil to a depth o 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay a Adobe❑ Hardpan Previous Application Made: (If yes,dote........... .......J No [&/New Construction: Yes [1 No R3-"FHA/VA: Yes ❑ No TYPE.OF INSTALLATION AND SPEC - ' + - T t.. .;_. ,,,,.,_-_- • - - «-� -� .. - - .- - _+ (No septic tank or cesspool permitted�ifpu_blrsewer fs evatlabie` ithin 200 feet.) - :■-� ; ��.- - t�O_..-•----.•.Material- Septic Tank: Distance from nearest welL.aQ-.____Distance frpom foltndation__. ,�-._....-....Size_� 4-j = Liquid dep+h.-` .. - Capacity. 1 L7 No. of compartments- Disposal Field: Distance from nearest wel _�1.'.�-.-•Distance frm foundation../D./.._.___.Distance to nearest lot line__.__ _....._ Length of each line.._�Q_....�d Width of french---._. f'1--------------- Number of lines_._-----�"-••----...--- ---• � Type of filter matDepth of filter material-1' `'..._...-Total 4ength..../ ------------------ ----- Seepage it: Distance to nearest welI-/P.0.�_...-.Distance fro foundation...lQ__._.--Distance to nearest lot line..�--- Linin material-_.__ Size: Diameter__.. 3. ......Depth-•- �� ---------•-- I Number of pits.,.----------- 9 - Cesspool: Distance fyom nearest well..---------_Distance from.foundation....................Lining material------------------------•.-------. Size: DiSmeter--•-•----------------•-------......Depth...----.............-..,..........................Liquid Capacity..............._.........gals. ' .Distance from nearest building Distance from nearest well--.._.-_..._.. •.----------•-••- ----•--..._..__...-.._---------------- Privy: __--•-••--•-• Privy: _....__.._. .----------•------------- t Distance to nearest lot line.........------------------------------------------------------ ' 1 --------------•----------•-••------------._... Remodeling and/or repairing describe):...._.`-'-"- '••' r __ -- -, ........................-•-------_ I hereby certify that I have prepared this application and f the workwill be done in accordance with San Joaquin County ordinances, State d rules and regulations of t San oaqu+ Local Health District. I Si ned ( 9 ) - nd or Contractor) y:.. -•- --- -..._---- .............. (Piot plan, showing size of lot, on of system in relation to walk, buildings, etc., can be placed on reverse sl e. s FOR DEPARTMENT USE ONLY : --------- .._.._..----------- DATE_...�__.�. ._�:6------------•----•- APPLICATION ACCEPTED BY------------ __•G/_ ... ---------•--- DATE-- -----------------------------------._._-_-------- --------------------•--.. REVIEWED BY-------------------------- ..................• ..._------•-------._ _ DINE..---.....___.—_.__-----.-.._. BUILDING PERMIT ISSUED.......-•.--------------------------_-.....__ _ - �_ - _ _- - - ......._: -- -------------_..-... Altera+ions and/or recommend'alio-'hs:------------------------------------------ ------- ...•-__ —------ --- 1i -----------------------------. -------- - .................. - ; ...__.. -----.- _ FINAL INSPECTION BY - SAN JOAQUIN LOCAL HEALTH DISTRICT 126 Sycamore Street 205 Wast 0th Street 1601 E.No:elten Ave. 300 West Oak Street Tracy,California Lodi,California manteca,California Stockton.Cat{fotnla Il r.r.ca.