20406 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: --------------- ----------- ------------------------------------------ --- APPLICATION FOR SANITATION PERMIT Permit No. ___________ ---------------- -- _-- --- __.---- (Complete in Duplicate) Date Issued �_-__ _. _________________________________ 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 County Ordinance No. 549. JOB ADDRESS AND,LOC N f ------------------------------------------------- - � Owner's Name ------ -- ------ Phone------------------------------------ Address � 'r -Y �tQ ---- ---------------------------,�, ------------------------------------------- ---•---------------------------------- 217W Contractor's Name---- Y ------------------------! fa ---------- ---]"e----------------------------------- Installation will serve: Residence {] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I----- Number of bedrooms _3____ Number of baths Z'____ Lot size •_-__-!�' __________________________________ Water Supply: Public system ❑ Community system ❑ Private ® Depth to Water Table 10- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 91 Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date___________________) No ❑ New Construction: Yes L) No ❑ FHA/VA: 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_..1_Q_.-------Distancq fr m foundation____�0_*____--.Material-----------------------------------------f -------- ® No. of compartments___.�'__._________.__SizeY_>t.:'t_ _'r_S_____._:--.Liquid depth---- -------------------Capacity.j.-'_-____-____ Disposal Field: Distance from nearest well_4_0 ---._Distance from found tion_.-� .________.Distance to nearest lot line_ ..-__.______ Number of lines___!- Length of each line_- p -------- ------------------- --- -t7_--=�-�-°�--.Width oftrench--��----------------------•-- Type of filter materia -------)f of filter material_jf_~----------.Total length__;X".Y_9________________.____-____ Seepage Pit: Distance to nearest well-----_----------------Distance from foundation--------------------Distance to nearest lot line----------------- n Number of pits______________________Lining material______._..-_.__-_______Size: Diameter____________-_____...__Depth-------------------------.______- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material__-________________________.___._. ❑ Size: Diameter---------------- ---------------Depth--------------------------- -----------Liquid Capacity----------------------------gals. Privy: Distance from nearest well________________________________ .__-_Distance from nearest building______________________________._.__-_____. ❑ Distance to nearest lot line-------------------------------------------------------------------------------------------- -------------------- ----•--•------------------- P 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, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) .____________.___________________________. __ __. __________.__.____Owner and/or Contractor B • --------------------------------------------(Title) --- -- ------------- (Plot plan, s owing size�ofi lot, location o system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- �'` ------------------------------------------------------------- DATE-- " � ' ----- - - REVIEWEDBY------------------------------------------- --------------------- ------ -- --------------------------------- DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED--------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations:---------------- • ------- ------------------ .-...---------------•---•-----------------••---•--------•--•-•------------•---------------------------------- -------•-•------------------------ --------------------------•-------•----------------- -----------------------------------------------------•-------------•---• ------------------•---- -----•-------.........------ --•-------- -------------------------•- ----------------------- ---------•-- --••-•-•------------------------------•--------------•-------••-------•---------------------------------- --- ------•----- --------------- ----------------- ------------ ------------ -------------------------------•------------------------------------------------------•----------------------------•-------------------- --------------- ----------------------- FINAL INSPECTION BY.�� . ---------- ---------- Date-.y-JI-__16------ ------------- --------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1801 E.Ho4elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,Califorfria F.P.00.