4135 - Laserfiche WebLink

Home Browse Search

'7 APPLICATION FCS SANITATION PERMIT Permit No. V (Complete in Duplicate) .7 Date Issued .... Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein d scr'bed. ,, This application is made in compliance with Coun Ordinance Ny JOB ADDRESS A��N!!}}D LOCATION- ----. d____________ _ �__._. Owner's Name.....ft - golw......--bio-i-=- ... -------------- -- ------------------------------------------- Phone--ff.,6_�---------•---- Address.14A.q.'r; --C"-� ` 1..... - �d �' �� `�------•-- -------------•------------------------------- --.. .-- ------- --.----- Contractor's Name........ Phone_ Installation will serve: Residence §& Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---f___ Number of bedrooms_ Number of baths ...t... Lot size ---/._5`Q_---�t._ ...... Water Supply: Public 'system Community system ❑ Private It Depth to Water Table Jr. ft. Character of soil to a depth of 3l-feet: Sand X Gravel ❑ Sandy Loam ❑ Clay_.Loam-❑ Clay❑ Adobe❑ Hardpan b Previous Application Made: Yes tT No New Construction; Yes JZ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available wi#bin 200 feet.) Septic Tank: Distance from nearest well_6"& _____Distance from foundation./-O-----------Material_ - ao ' No. of compartments------------12........... _Liquid depth_..4 `_________________Capacity_ Disposal Field: Distance from nearest well__o�-------Distance from foundation.....Id----------Distance to nearest lot line_- ---" fNumber of lines............ _ Length of each line 3-_� _'t.4.._.WPdth of trench _V "....... ......k Type of filter material-__- -------Depth of-filter material...../.*_*':___-Total length......A�.-`..__. _.- Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line__._.-. __...`... ❑ Number of pits_________ ____________Lining material._A --------------Size: Diameter___.-__ ---___-___ Depth---------------------------------- Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material-:_ --------- - ------- �y Size: Diameter -T--- --- ------Depth-----------------------------------------------------Liquid Capacity -.:—.g------- - 4-[i. Privy: Distance from nearest well____:____ _____________________ ___________Distance from nearest building------------------------------------------ El ______.•_ _____-_-.--_____.-_--__,_.❑ Distance to nearest lot line-------------------------------- -------------------------------------- --•------- Remodeling and/or repairing (describe)---------------------------------------..,.---------------------------------•--•... ........................................................ ------------------------------------------------------------•----•---•- ------------------•--------------------------------------------.--- ------- --------------------- ---•--- -----• ------- I hereby certify that I have prepared this application and that the work will be done in accordance with San 3"ggin County ordinances, tate laws, and rules and reg Ins ns of the San Joaquin Local Health District. . _. _...._.._ • --------------Owner and/or Contractor (Signed).. -- ---------- �.. _ _ ___._._ BY . ------- ------• .----------------------------------------- ---- ------(Title)---- ---------------- ----------------- ----- - - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on.reverse side). FOR DEPARTMENT USE ONLY - APPLICATION ACCEPTED BY -- --- --------------- •-- DATE. REVIEWED BY -------- DATE ; .. .. ---------- BUILDING PERMIT ISSUED..... .... ----- �. ------•--- .... t.------------------------------------------- DATE.............................. and/or recommendations:............. ...--•-- - ------ --------------------------------- ----------------•------•------...................................... •-•--••-----------••-•---•-----•--••• ...................................................................•----- ---•----• ---•--•------••-•------------••---•----•-------•--••-------------•--------•-•-•---------•••--•- FINAL INSPECTION B . " "Q""¢=------------------- Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C"Street Stockton, California Lodi, California Manteca, California Tracy, California '` ES-9-2M 10-52 Revised W-2100