SU0005179 SSNL - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION P'RMIIT Permit No. .p....7 5 . (Complete in Duplicate) G Date Issued � /Y....�� 'r: �. '.':�° �4�" i��Yhis Permit Expires 1 Year From Date Issued Application is hereby meds}o the San Joaquin Local Health District for a permit to construct and :nrtall the work herein described.This application is made in compliance with County Ordinance No. 549. Q,. /� / JOB ADDRESS AND `yO'C/A11 N.............oS�.L. .3.....:. .... ......... fL? ..0..�-Gtr....lf�lf•.•--........_..........._.._ -- '. Owner's Name �./.1:�I ... ...... .......... ........ Phone..................._.... .. .......�. .... R..!77.2.,5... . . . _. rlAddress.-..................................... ..6 .ai_... . ..t..........��t=L..t./Gr.....................:::................................ .. Contracfor s Name...._......._. �Q.�.... ........ ............................... Phone......................... .. t ...... .............. , Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑"%.,Ofhnr �f� Number of living units: .,3.. Number of bedrooms.(�..Number of baths.. Lot size ../.......................�>�......_......._........... n Water Supply: Public system El Community system ❑ Private p-9'epth to Water Tableg.7. . ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel❑ Send Loam❑ Clay Loam❑ Clay❑ Adobe nardpen❑ Previous Application Made: (if yes,dote.. .. ...._.....J N New Construction: Yes{ to ❑ FHA/VA:Yps L No❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic Tank or cesspool permitted if public sewer is available within 200 feet.)< � Y �A7 Metonel ��.tR.�/. d i septic Distance from nearest we!L..�:Q.. .Distance from founds.Li . .eo / No. of compartments.....,,.... ....Size..�T..!�j.Sw�Slo Liquid depth ..Y%/..]...."."-Capacity..,.cWO } Disposal geld::` Distance from nearest well;'Z.......Distance from iound&tion../Q_l.......Distance to nearest lot line...S..�...... Number of lines.......3.... ....................Length of each line.-Zo,- 0/ ./..f°..Width of trench .. ...I.................. ' ' '.Typo 0f filter materiaL.).2 ..�stc,�-Depth of filter material:...��... Total length.- Q.D............. Seeps Yit: Dislance,to near t well- .. ........ Distance from foundrtion IQ. ..... stance to nearest lot link W q Number of pits �.. .... Lining rnaterial aC_). .Size: Diameser .3. .. .....Dopth. �.,S . :Cesspool: Distancb•'From nearest Well. Distance from tom dafion ................Lining material............... .. ElS!z Diameter... ........Depth.... . . ...... ....Liquid Capacity...... ._............ gals 1� Privy: Distance from nearest We[!..............................................Distancerom nearest building.......................................... „� ❑ ........................................................................................ ?eta Distance to nearest lot line... ...... .. ... ... . .. ! Remodeling and/or repairing (describo): .....e'-2'/J -. 'd""'yKVZ/r ._.. ' ...................................._................................................._........_.........................- .. . ................ . .... ........... cam." .:�� - .......................I.............._........................ ........................................................................................................................................... .... ........................................_.................................................._ ....... .... .. I hereby certify f eve prepare his application and that the work will be done is accordance with Sen Joaquin CoWity'1. ordinances. State lay4, and ulos end egu Ions of the San Joaquin Local Health District. / ........................................ (Owner end/or Contractor) (Signed).... (Title) ..... (Plot plan, showing size of 1 , 10 tion of sirs em in rel)fion fo w uildings, etc., can be place on reverse side). c FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED By.- ..r.. .-�.t.D..: .. ....._...... ....._.. TE.......a.-Jj...�a__...................... _._........ DA l!,--.... /'' DATE................................_.................._.... REVIEWED BY....................._...................... P ...... BUILDING PERMIT ISSUED.............................................................._...................................... DATE._........._............................................._ Alters#ions and/ r rec mm ndafions ;',�'t ..... ................. C 6.- -6 .. ....... - - e'P ,ff //�,_..�1•t. <scyr�c tae .X .. �. . _ �we....�..... '..... .................. .................................. ................................................................ f,7 z7 FINAL INSPECTION BY:..... ...... .i — - SAN JOAQUIN LOCAL HEALTH DISTRICT - 1601 1.Navben Ave 300 W911 Oak Sirs91 124 SYsemen Stn9t 305 W.st 9th Sttl91 bs<Non,Celilernia fedi,California Mantrm,Callfernia Tr9q,Califernie CS 9 RCvIG[D