22587 - Laserfiche WebLink

Home Browse Search

FUK OFFICE USE: Y r --------------------------------------- ----------------- APPLICATION FOR SANITATION PERMIT Permit No. ------------------- ---- ---------- -------------------- ----------------- (Complete in Duplicate) ------ ------- -- This Permit Expires 1 Year From Date Issued Date Issued 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. JOS ADDRESS AN LOCATION__ ----- _-- -/ ------------------------------------------- , Owner's Name------- ------------------------------------ ----- ,� ••------------------ ------------ -- -- - Phone__. ------- - -- '34390- .111711 Address_________ f Contractor's Name---- -' -- -' ,E -------------------------------•-- ------ ----------- Phone---•--------•------------ Installation will serve: Residence ❑' Apartment House ❑ Commercial Trailer Courts❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size ___ 4' �4-V----------------- Water Supply: Public system ❑ Community system ❑ Private t, Depth to Water Table __{.__ ft. Character of soil to a depth of 3 feet: Sand ravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan,❑ Previous Application Made: (if yes,date.---................) No ]'`New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE.OF INSTALLATION.AND SPEC IFICATlONS: � _ --� -- _ (No septic tank or cesspool permitted if public sewer is available within 200 fee_t.) `Y' Septic Tank: Distance from nearest weil_________ ______Distance from foundation------------------- Material____ _.__ _._______-- ___ - _ - - --------------- ❑ No. of compartments Size - Liquid depth --- �� ' r= iCapacity-; ------------- g Disposal Field: Distance from nearest welj� - - •Distance from foundation/ ;--l-Distance to nearest lot lir s ❑ Number of lines------��----------------------Lengfih of-each line,f�-,fl' --p,-----Width of trench -- -----,-- --- r. T e of filter mater•i'a` p YA �� De th of;filter material-- --- ---'`- '---._.Total length__�� - e------------- 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 ❑ r Size: Diameter- --- ------------------------------Depth------------------------------------- -------------Liquid Capacity----------------------------gais. Privy: '4Disfance from nearest well----------------------------------------------- --Distance from nearest building--------------------------------------- ❑ Distance to nearest lot lire------ ----- 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 Joaquin County ordinances, State411aws, nd rules and regulations of the S Joaquin Local Health District. (Signed)-- - - ---------- _ a. --=--------------------------------- -------------------------(Owner and/or Contractor) By:. - - -------------------- - - -_:_:------'_Title...... - =-_- --- (Plot plan, showing size of lot, locatign of system in relation to wells, buildings, etc., can be placed on reverse side). �1 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- --" i. -0w----------------------------- -------------------------- ---------- DATE------- -Z✓--`-�'�------- REVIEWEDBY-------------------------------- --------------------- --------------------------------------------------------------------- DATE-------------------- ------------------------------------ BUILDING PERMIT ISSUED---------------------------------- ------------------------------------------------------------------ DATE - ---------------------- Ater$tions and/or recommendations:------------------------ __ till t (1-%4% 11_,'�A l C V'- - ---------------- ------•------------------ ------------------- --------------------------- --------------------------------------------------•------------------- FINAL fNSPECTIONBY:.-_-/-�`--Zz-- �Q SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.0 O. s a