SU0011633 SSNL - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: _, ---- /S/ ..` -•------------- ----1� Permit No. 5 � - o APPLICATION FOR SANITATION PERMIT _ (Complete in Duplicate) Date Issued .... ................... This Permit Expires 1 Year from 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 with County Ordinance No. 549. / Ln ,/�GC:Z} ----------------- JOB ADDRESS AND LOCAT)ON..�______________I-------• ---- Owner's Name------------- FIs"k r` -1 :rL:.a<tx_� te_ 2J------------•-----or Phone" ,, � .wy�a{ �..--- --------------------------------- Address--------------------- '/ r -Gr 2__�:te�%r. _a. ...... `-9 :*r= '-----..-•---------------------------- Contractor's Name.__...______!"-- Installation will serve: Residence ❑ Apartment House El Commercial E3Tr Trailer t ourt `Motel ❑ Other ❑ Number of living units: --- Number of bedrooms _.-__-. Number of baths .__.._- Lo st ls. ------•---•-•"-- Water Supply: Public system Community system El Private E] Depth to Water Table .6Q ft. F Character of soil to a depth of 3 feet: Sand E] Gravel El Sandy Loam ❑ Clay Loam❑ Clay ❑ Adobe Hardpan❑ Previous Application Made: (if yes,date....................) No 0 New Construction: Yes ❑ No X FHA/VA: Yes ❑ NON' 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------------____Distance from"foundation--___-___--- ......Material---------_.____._-"__._________--_-----------". ❑ ,,, : i�f� p Liquid depth-------- --------Capacity---------• --------.-_. Gy,.� No. of compartments ---- -------------Size-----•-•-••----••---- •-- ---- , Disposal Field: Distance from nearest well.................Distance from foundation....................Distance to nearest lot line___________...___ �) ❑ ovj Number of lines._..--------------------------• --Length of each line--------------------------....Width of trench--.-..-.-----,--------------------- U Type of filter material.______._.__..-----.-.Depth of filter material_______________________Total length_.__.______._..._:_.____----------------- J ' Dist nce to nearest lot line__.'-�_'�.�---- Seepal a P• : Distance to nearest wei1"71�12 _--Distance fro, fou dation._._AIV"--.--_.--- Depth__..___...._r � I t Size: Diameter __ --- . �c �j � � Number of pits--------`�...--_"_--•Lining material_____:__. 1 d Cesspoo�: Distance from nearest well.________.___.__Distance from foundation-------------------- material_.._. --------------------------------als. � Size: Diameter------ ------------- -----------•----Depth- -------------- ------ ---------•- • ❑ Liquid Capacity 9 ....._Distance from nearest building___________________________________---•. .. Privy: Distance from nearest well------------------------------------------ ❑ Distance to nearest lot line_.-_.------------------------------------__-------------------------------------••--- .......... Remodeling and/or repairing (describe):._..___ �� `°" "' ��`"""`"t`4 " ----------------------" " ------------------------- -----"-•----- -- ---------------•---------------------- -------•--------- -------------------------------------- ------------------------------ -------• -•- • --------------------------------•-----•----•------------------- --•------ --- --•-------- - -- --- ------ ---------• - --------------------------------------------- ---------------------------------- ill be done in accordance with San Joaquin I hereby certify that I have prepared this application and that the work wCounty ordinances, State laws, and rules and regul tions of the San Joaquin Local Heath District. 1 _______________(Ow rand/or Contractor) (Signed)-- / !1!i •�-- - � -- - �� - - -- -•---•-----------------••-•-----•----(Title)----"--•-- ------• - ---•-- - --.. ...... - - ---------- By:_....------•---••----�G�i� ....�� l (Plot plan, showing size of lot, location of s em in reltion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --"� --- ----•-------------------------------------- ------ DATE._..__._-S ' REVIEWED BY------------•-••-------- •---------- ----------------_-----------------••-- DATE.-------•---------•-----"-"---•---------•-------•--•------ DATE------ ------------- -------------------- ----- BUILDING PERMIT ISSUED-------------------------------------- - � t Alter tion; and/or recommendations:.------- = .-�--�------`�-�-� /'- / "��-'1��•'-- -- - / . �. Q - -- ......."'"T:. (---'-,-•----"---- ------------ F . ...... ....... s= =�- -... -�. ---- `-',l'---------- ------------_------------------•---------------------------------------- --------------------- ------- --------------------------- ---- ----------------------- ------- ----- � Date-------- --,If- 6 • FINAL INSPECTION BY:..-....... SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 west Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California Cr 9 REVISED S-S9 31A 3-•63 F.P.CO.