SR0082741_SSNL - Laserfiche WebLink

Home Browse Search

rUK UH-ILL USt: ........................................................ APPLICATION FOR SANITATION PERMIT Permit No. ` P_/ . ................ ............ ------•--•....... -----•• (Complete in Duplicate) {� Date issued ................................................. This Permit Expires 1 Year From Date Issued fr'� 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. , l JOB ADDRESS AND OCATION.14..2o-1�j __.6 ___ _ ..T� ter.. ......... - Names......... ...... Q ---------- Owner's ' Phone Address.. -..._��...... •- 4'.+�e------------------ .-.-•---- --... .. ....-•----- ...---...----•---•-•-----....------••--•----......---•------•-. ...._.. Contractors Name.. ;��use -✓..---..--••--•-•--------- Phone................................... Installation will serve: Residence ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J.... Number of bedrooms -_-l._. Number of baths ...I.... Lot size ....4 ....+ Water Supply: Public system ❑ Community system ❑ Private [[Depth to Water Table __..._.. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam❑ Clay❑ Adobe❑ Hardpan Previous Application Made: Ilf yes,date....................) No ❑ New Construction: Yes ❑ No ❑ FHA/VAe Yes ❑ No ❑ 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................................___-__-_-__-. ❑ No. of compartments.........................Size................-...............Liquid depth..........................Capacity....................... Dispos ` ield: Distance from nearest well.....&.....Distance from foundation.....Ja........Distance to nearest to iline...s.......... Rr Number of lines........ ..........Length of each line.........1.00.............Width of french......%............................ Type of Cter material....... N.!.._.__..Depth of filter material --------Total length........1.04.......................... � Seepage Pit Distance to nearest well....._.J..CA.....__Distance from foundation..-.j.0_....._._.Distance to nearest lot line..._....... G ,❑� Number of pits.........I...........Lining material-_---.-S,12. ...--.Size: Diameter------3��_.......Depth----- ................ (� Cesspool: Distance from nearest well................Distance from foundation...................Lining material................______._--.--__-._-. �!1 ❑ Size: Diameter_. ................................Depth..................... -----_-•--•------•---------Liquid Capacity............................gals, Privy: Distance from nearest well............... ....._._......_.._.....Distance from nearest building.......................................... ❑ Distance to nearest lot line.............•------------------------- --- _ -------------------•-----..........-••--...--•-•--••-•-...._------....---....•-----•-•---- Remodeling and/or repairing (describe):.............................. .. ... . ..•--••--•-----•--•-------•------•-•--.--•--.........-•----•--..........._..--------_--_---_-_--•---- -•....................•-----..............._•-----••. -- -----••••------------._............._....•----....-•----•---•---•-----..._...---- -----••-------•--•.....-----•-----•......••---••.........---.._.........----_.... ............-.......---••................................................. •-•-----•----•-•--...... .............-••-•--••--•-------------•--•--•. ............................................... I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances. Stat s, and rules and regulations of the San Joaquin Local Health District. (Signed)-•...... .................. ----..----........._.....-----------._........._...-----•--•-•---•--------•--- -••----• mer and/or Contractor) BY= {Title}. .--•......................... ...._............. (Plot plan, showing size of lot, location o syste in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- .. ------ - ---------------------------------•- _ DATE-- -• . --4. 4-•-------•------ REVIEWED BY . - DATE......*.................................. _ ........ PERMITISSUED.............................................................. ••.._........._... ..... DATE............................................................ Alterations and/or recommendations:.---.................. --- ....-...._ ._ ........._......--•-•------........--•---••-------•--•-......---.................... ---•......................•-•--•.............._...........__....._........_........----...........---------•------••--------••----••---•----•------••-----........-- ----•••----.._..-•-...............----•--•-•--.....-•-•-- ---------- -- --•--•----•--•---•-•-------•------....--.............---•--............. ................................................................--•-•--•.----•----•-•----•--•-....-•-------•-•----................... - -----------------•--....--•.............._................._.........................--------......._------•--.....-- •. .........---.....-----•-•-•------....----•-•-------•-•---••-••-•--...•••--...----.....------•--•- .......----•-••..........................................................................................................•-•-•-.........----•................................................................................ FINAL INSPECTION -•-:---------••- ._ Date-_/, .:' '_f7..`.........................................---•--••--- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 i.Na:oltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California r.P.cn.