SR0082330 SSNL - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: L./ta........______________.......ld...-- APPLICATION FOR SANITATION PERMIT Permit No. J (Complete in Duplicate) L --------- - •-__ .... -••--- ----.•.. This Permit Expires 1 Year From Date Issued "Date 'issued l.- 3...� . 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 fm compliance,with County Ordinance No. 549. JOB ADDRESS AND LOCATI N �` 'j�p_ r ==-=•----------•-••-----•-•.................. _-----•._:.. Owner's Name,. 1 Address..... .. !.:__._. .... . ________________•___..____-__.___.._._ Contractor's Name........ .. ✓ ____�. _ �a -................ :; w-'�-'-.--�. *•---.._._...--------...----••-.....-- ......-•-•---•-----••---•-------- Installation ! Installation will serve: !tRe iderce '�pa�riment"Ho e❑ Com a cia7 Zo '-jTrailer Court ❑ Motel [] Other❑ Number of living units: _._: Number-of bedroom's if.. Number of.baths /_._ Lot size�.7/_ ��_ ______________ ._..._ ` lr .. _. Watef Supply: Public system ❑ Community;system ❑ Private (�epth to Water Table .Ant. ` Character of soil to a depth of 3 feet: ' Sand ❑ Gravel ❑ SandyfJ oam❑ Clay Loam ❑ Clay ❑ Adobe gr-_H rdpan ❑ Previous Application Made: '(!f'ye's-dote-``'=____....-_.1 NoJ21"�New Construction: Yes Jo'1Vo ❑ FHA/VA: Yes ®r•No❑ \. \ TYPE OF INSTALLATIND SPECIFICATIONS: ` (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from ne'arest.',e_I_..Ai7.:__.Distance from_ _ /fo�y/nda'Liquid on...fi arim ........ Size4KtI de..t-_h-_.:_M,?1_alt` -•_Capacity Ac:_...�_p.._0 _No. of cam - Disposal Field: Distancelfrom neare,vv�� well___] r T___.Distance from foundation,_,f�_ ._.Distance to nearest loft line.! _"._._ Number: lines____.tom__-__.. :._:.-__'-"_.�.. rLen'th of each line___ sof Width of trench_ +�y�......................... Type of.filter materiaL4 rlkDepth of filter material-,,/!fe� ___--._Total,length..__ZorOY..:........................ .� Seepag Pit: Distance!to nearest.'�wtell......* .._...Distance fro fouda tion,_,e,9_._.__...Di co to nearest lot line.07 ..... ..�' ` Numberof pits_..,,F9-......._-Lining material__ :Size: Diameter.' .......:.......... °O i • Cesspool: Distance'from nearest well:.___________._-Distance from foundation__..................Lining material-------...............................rn [J Size: Diameter•:.�*. .......... •---._... .._DeP h---......_. --•--•............--------- ----.Liquid Capacity.............................gals. Privy:_. Distance.from:nearest well____------------_.......7_---------. ..-..-_....Distance from nearest bui)ding........-............................... 0 Distancetto ndarest lot'line....: .._......... -......... .-----•. ............................ ••-•----------- Remodeling and/or repairing describe _______ ______ -- F i -..--------- •r - --••--•--- ----------••-•-- I hereby certify that I heve;prepaied this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and frule's and regulations of the San Joaquin Local Health District, (Signed)------------------` .. ..... .. ... . ................... _.-------........ n'Contractor) B . '' .---�--------------------.......:...........------ - (Title).... % ��--'•` .................... (Piot plan, showing size' oflot, location of system in.rel in to wells,,buildings, etc., can be placed on reverse side). ' FOR DEPARTMENT USE ONLY APPLICATION:ACCEPTED BY.............�.'- -t �-__------- ...._......---•---_-----------_----------- DATE----- .1�s2."�-�--�-3. - - REVIEWED BY - _------_-_-------------------- _._._._._-.__.__------------------ :.. DATE._ ....... -••------- ------- .._.. BUILDING PERMIT ISSUED-------------....... = - ----•-- Di4TE..------•--•---- ------------------------ Alterations and/or recommendations:..... .............._..._...____... _ ._ __..._ _ __-- -------1._�--,,5`._:�:: .l•� . "_.. OAF;__-��'�-- --�---• --- _ . . 4�- v . -- [ --•- n� 1 ..._.• '.r.�':. ...... . FINAL INSPECTION By:-.,-,....C.. ---------------.............. Date.......... _... SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stoddon,California Lodi,California Manteca,California Tracy,California 95 9 REVISED 0-69 3M 3-•63 f.P.r D.