21556 - Laserfiche WebLink

Home Browse Search

FOROFFICE USE: ---------------------- --------------------------------- _-.._.-.___._....................... .. ...... -------- 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 madompliance with C Ordinance No. 549. rr JOB ADDRESS AND IV TION------------- - - __. - ------ Owner's Name------------------------ 3 _.-----•-------• ----- -----------------�--------- ------------------------------ -------- ------- -------- -------------- Phone--r Address---------------------------------------- v� {�- 1' �--•------------------------ Contractor's Name ----------------------------------•--- •-- ------------ Phone----------------------------------- Installation will serve: Residence Ej�-Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -----L Number of bedrooms .--T 'Nom of baths ---L Lot size .___26--_09.... ________________________________ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table l.0 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑' Sandy Loam ❑ Clay LoamClay ❑ Adobe ❑ Hardpan ❑Ts Previous Application Made: (If yes,date.............. ) No ' Pp [s�� New Construction: Yes ❑ No [� FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: Ad" Ler �x T -{No-septic tank or cesspool permitted,if.public sewer;is a.vaila61e.wifhin,.200.feef.), Septic Tank: Distance from nearest well---S --------Distance from foundation_----_ll_Q--------Material-------- - -------- ------ ®� No. of compartments----------a-----�---Size----- -- -----_--_Liquid depth-------�t----------Capacity----- -------- Disposal Field: Distance from nearest well___ _--Distance from foundation---!V_________-Distance to nearest lot line____a4_________ ©� Number of lines-------------- __________________Length of each line---------- ---------------Width of trench----- yy______.-___---------- Type of filter material P_-c--______Depth of filter material-------lip---------Tota) length_-_----- Seepage Pit: Distance to nearest welf------------- ------ -Distance from foundation--------------------Distance to nearest lot line_--__-___..____-- ` ❑ dumber of pits----------------------Lining material-----------------------Size: Diameter--.-------------,------Depth---.----------------------------- Cesspool: Distance from nearest well_________________Distance from foundation-.-.---------------------- __ ❑ Size: Diameter-- --- ---------------------------- Depth-------------- ---- ---------------------Liquid Capacity---------- --------gals. Privy: Distance from nearest well---.---------------------------------------------Distance from nearest building-- __.___.-----___.______-----.___..__.._- ❑ t Distance to nearest lot line--- - =--------------------- --------=---------------------------------------------- ----------- ---------------- ---------- - --- Remodeli and/or repairing {describe) - ----- --------------------------------------------------- --------------------------------------------------------- ---•------------ •------------------------------------------------------------------------#---------------------------------------------------------------------------------------------------------------------------- -- ------- --- - --- ------ -----------------------------------------------------------------------------=----------------------------------------------------------------------------------------------------------- I ce tify hat I have prepared this application and that the work will be done in accordance with San Joaquin County ordinan t law and rules and regulations of the San Joaquin Local Health District. (Signed)- --- ------ --- -- •---------- ------------------------------------------- --------------------------------------------------------------- (Owner nd r Contractor) [Plot plan, showing size f lot, location of system in relation to wells, buildings, etc., can be placed o eve�se side) " — FOR DE RTMENT USE ONLY r APPLICATION ACCEPTED BY -------------------- ---------------------------------------- DATE---------- _` - ± REVIEWEDBY --------------------------------------------------------------- ------------------------------------------------------------- DATE ------------ BUILDING PERMIT ISSUED------------------ ----------------------- ----- ----- - ------------------------------------. DATE. Alterations and/or recommendations------------------------ -- -------------------- ----:----------------------------------- -------------------------------------------------------------------- --------------------------------------------------------------------------- -------------•--------------------------------------------------- ---------- -------------------------------------- ----- -------------- ---------------- - ------------------------------- ------------------------ -- ----------- -------- -- -- v FINAL INSPECTIO Y:.. . . --•--- ------------ Date.-------' =r I �. - JOAQUIN LOCAL HEALTH DISTRICT 1601 E.No:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th street Stockton,California Lodi, California Manteca,California Tracy,California