19852 - Laserfiche WebLink

Home Browse Search

FOK OFFICE USE: f/ -A --------------- ----------- APPLICATION FOR SANITATION PERMIT Permit No. .�/..--- -"- ---------------------------------------------------- [ p g . - ) --- ------------- Cam late in Duplicate) Date Issued �_.��S This Permit Expires 1 Year From 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 C y.Ordinance 549.- „-0, . ��._. --- --- .-- , T= I JOB ADDRESS AND OCATION__� - `' :G ------------------------------------------- --------- _ ,.....w r.� L == - - Owner s.Name - - ------- rr ------•I ---•--- --- Address-----i---------- _4�_ --- --•--•--------- �c'[�'C ------- - --- - T a_.._ .Xy�. Phone4 . Contractors Name-------------- Installation Apartment ❑ ❑ ❑ 0 her ❑ al well seive Residence , umbert f bedroomis--Z.'_CNumberlof baths railer Court e ' o �� t ----------------------------- Number of living units: Community system ate De I Water Supply: Public s s e j y y ❑ e ❑ pth to Water Table "- ft. PP y: � . . �yti. m .. un em � . k Adobe Hardpan Character of soil to a.depth.of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ ❑ M z y New Construction: Yes ❑ No FHA/VA: Yes ❑ No� Previous Application Made:`Ilf ygs,dcite:.......... No.� IOF IN, "AND SPECIFICATIONS-1— TYPE (No septic tank or cesspool permitted if public•sewei•,is available within 200 feet.) } I # s: .., Septic Tank: Distance from nearesr well___ _________ Distance from foundation-------- -----------Material------- ------------------------------------ -- ' D 6, i5�f No. of compartments,---.�'...........--"Sizer-£=--- •--- Liquid depth-----------------. Capacity Disposal Field: Distance from nearest well............... .Distance from foundation__"_-__._--_.__"_.Distance to nearest lot line_.______..______. ❑ EXLS'��N6 Number of lines-----------------------------------Length of each line. __ Width of trench. -.-- - - $ Type of filter material-------------------------Depth of filter material--------------. """"---Total leng+h_.______...------=-----------------r " - \ 1 ____-_-_Distance to nearest lot line- Seepage Pit: Distance to nearest well..l3��_N_ "--Distance from fout<da#ion__,lQ Linin material_.ft.�1�-.Size: Diameter.-,?.tri-"."" ""-"Depth--- �, � Number of pits --- g 7.S7 ------ � Cesspool: Distance from nearest well_.___.____-..__Distance from foundation.................._Lining material.._.-___....__.._---------"-"" ala. El I,i Size: Diameter------------- ------------------------Depth----------------------------------------------------Liquid Capacity---------------------- 9 Privy: 4 Distance from nearest well__--------------------------------------- ------Distance from nearest building------------------------------------------ ------------------------ ------•--------------. , r � Distance to nearest lot line----- ------------------------ - --------------- - ------------- ---------------------------- Remodelingland/or repairing (describel-------------------------------------- - ----------- ---------------------------------------- -------------- -------------------------•- 4 - ----- -------- - -- ----- --- ! ------------------------ ------------------------------------------------------ --------------------- -------------------------------------- --- ------------ - I � Cr u�...� e�- -------- ------ S`al— ----- b�� 7�r`�v p ----------------------- - -- Ihereby certify ve prepared` this app icati and that the work will be done in accordance with San Joaquin County ordinances, $tate la , and ules and ulati ns oft San Joaquin Local Health District. i _ caner and/or_ / r Contract ) a �. �--- `-- -- - ---- ---- -- ----- -- - - ----------(Title)--------- ------------ ---- ---------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be place n reverse side). I FOR DEPARTMENT USE: ONLY i APPLICATION ACCEPTED BY---"----- --------------- DATE------------1// --9 ------- ` REVIEWED BY-------------------------------------------------- --------------------------------------------------------------------------- DATE--- --------"-------------------------------------------- -- DATE------------------------------------------------------------ I 1 BUILDING PERMIT ISSUED------------------------- �;�----- -- -- - - - �' _ _ Alterations and/or recommendations: �1. ` � ------------------------------------------------ ---------- --------------------------------------------------------------- ---------------------------------- ---- -------"- --- -------------- ------ --- -----=---------- �f�� { ------------------ Date----------------- - -- --- --------- ------------- -- FINAL INSPECTION BY:..... .... .. ... ..--""-- t SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street i Stacklon,California Lodi,California Manteca,California Tracy,California i F.F.CC.