SU0004610 SSNL - Laserfiche WebLink

Home Browse Search

6, rvK vrric.t uae: _ _-__.-__-__--__--...--________ APPLICATION FOR SANITATION PERMIT Permit No. ---_/.ry_63-._ _-..._ is. ----- ----- -- - - --- (Complete in Duplicate) ._-- -_..____ -- -- ___- .-._- This Permit Expires 1 Year From Date Issued Date Issued -�Pl 0� y L Application is hereby made to the San Joaquin Local Health District for a permit to construct and install th r herein des ri ed. This application is made in compliance with County Ordinance No. 549. `- JOB ADDRESS AND LOCATION. 8,_,PA1f r__f1�r��[�f1Y --to/t_ f1il�- _-9� __-yX�_fJ //I;fle y �. r Owner's Name - �aqA�fr�Fs / Phone---- ------------------ Address-------- ------------- --- ------------------------------------------ Contractor's Name----- -------------_ ------ ----------'---------------- Phone------------------------_------- �' Installation will serve: Residence Vr�Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ..-_ Number of bedrooms e-.- Number of baths 1-- Lot size Bela- G-----_...- i ` Water Supply: Public system ❑ Community system ❑ Private V-'Spth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Arclay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date _ ) No �K New Construction: Yes JPI'lNo ❑ FHA/VA: Yesf%--_No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if publi�cq sewer is available within 200 feet.) , f, Septic T!La: Distance from nearest wIl ft- _Distance from f u dation_l0-_-_- Mafe ial-ee-A'_ ,e% _. SS1 X #�iL� � Capacity/"., No. of cam artments __--�--_-•__--..Size. c �wd depth__ ______.._ Disposal Field: Distance from nearest well.-, Distance from founda 'onE __---_--Distance to nearest logit line_*__._-.-_---� Number of lines-- _--__--_ _--_--_Length of each line-gQ_-_--_ Width of trench . _----______________. H 6. Type of filter material�e Depth of filter material- --__-_--_--Total length- 10 ---- ---_--._---_-_ 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_ -------_---------------------_. ❑ Size: Diameter--------------------------------Depth-----------------------------------------Liquid Capacity---------------------------gals. I` Privy: Distance"from'earest well----_------------------------------------------Distance from nearest building------------------_----------------:-- ❑ Distance to nearest lot line_-__--__ - --- -___----__---------------------------_-_- Remodeling and/or repairing (describe):_--_ ,�fi .�490&� -. -//` l�i... ...'_------------_------------------------------- -------------------------------- ----- V' -------------------------------'---'- --------------------------------------- -------------F------------------------------------------------------------------- ---------------------------- ------------------'--------------------------`-`-`-------------------------- --------------------------------- ----------------- --------------------------------`----------- - ` I hereby certify that I have prepared this..application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules a d regulations of he San Joaquin Local Health District. (Signed)---------------------� ------ --------------- ---- ----------------'-`----( Contractor) ►• By:---------------- --------- -------`------- ` - �sor�r -(Title)- -- -- - (Plot plan, showing size of lot, location of system in relatio wells, buildings, etc., can be pl9ced on reverse side). ` FOR RFARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------------- ----------------------- -- - DATE --------- - - -------------------------- j REVIEWED BY------------=------ ----------- -------------------------------------------- -- DATE - - BUILDING PERMIT ISSUED: ---------------------- -- -- DATE..- -- --------- - - Alterationsand/or recommendations:-----------------``----------------------------------- ---------___------------------------------------------------------------- �. ------------------------------------------------------------------------- ---------------------- ---------------------------------------------- -------- --- --- --------------------- -- - - ---------------------------------- ` FINAL INSPECTION BY:.-----------------,/----T--- C » _ Date- -------/-- --- ----L-—- SAN-JOAQUIN LOCAL HEALTH DISTRICT ` 1601 E.Haxolton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street