19380 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ------------------------- - APPLICATION FOR SANITATION PERMIT Permit No. - - - - - - . J ----------------------- - --- ----------------- (Complete in Duplicate) �j 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. Pell JOB ADDRESS A D LOCATION----- ------- ----- ------------------------------------ ---------- Owner's Name-- - -----t----- ----- Phone._.... Address a ! --------il --#6----� ' �' ' ------------------------------------------------ ----------------- Contractor s Name____________ _ ? --- ---- �' Phone._7- _✓ rr_ 'v' Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other �`d-c Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size -------� ---------•------------ Water Supply: Public system ❑ Community system F] Private Depth to Water Table __1_._ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ar-lHardpan ❑ Previous Application Made: (If yes,date----------_---------) No Er New Construction: Yes 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--- �-�___ _ Distan e from oundation---/_Q-------Material- ___-___"""�f-------------------- p� No. of compartments____.3_________P_ Sizey�� _C-� XS�-Liquid depth___.____�__�_____Capaciiy.d__y�e Disposal field: Distance from nearest welly-------Distance from foundation_.Z.?o.-------Distance to nearest lot line..^ ----- Number of lines.._.____'____ L Length of each line__Z4_d_.'_____---_-_-_.Width of trench.-_.__.ot__ _____________�.___ Type of filter material t- _-4=--_Depth of filter material____, ---Total length______________________ �0--.__-_ 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 foundation--------------------Lining material------------------------_______--_._ ❑ Size: Diameter------ ----------------------- -------Depth-------------------------- ------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------------_--------------- --------------Distance from nearest building------------------------------__--_.__.. ❑ Distance.to nearest lot line------------------------ --- •------- ----•- -- --------- Remodeling - ----Remodeling and/or repairing (describe):------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------- ------------------------------------------------------------------------------•----•--------------------------------------------------------------------------------------- -----------------------------------------------------------------------------------------------------------•--------------•----------------------------------------------------------------- ------------------------------- I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Se ws, and rules nd reg ations of the an J aquin Local Health District. (Signed)------- - -- ------- ----------- -- ----- - ----- , - --------------------- (Owner and/or Contractor) --------------- Title - ------ (Plot plan, showing size of lot, location of system i�n to w , buildings, etc., can be placed on r erse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- --- --------- -- -------------------------------------------- DATE---- ----- � ��-`S� ------------- ---------- REVIEWEDBY------------------------- ---------------------------- ---------------------------------------------------------------------- / ' DA TE----------------------------------------------------------= BUILDING PERMIT ISSUED--------------------------------------------------------------_ -- _�!-G;� DA - ..-- - Altera+ions and or recommendations: _ --------------------------- ---•--•-------------------.--------------------------------- --------------------------------------------------------------------- ---------- ----------------------------------------------- ---------...:-----------------------......--------------------......_... ------------------------------------------------- --------------------------- ------------------------------------------------------------------------- -----•-------------------------------------------- ------------------------------ ---------- --------------------- ------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------- - FINAL INSPECTION BY: ..... l�•L.�,..X_ __ Date - --------- `` ------ ------------------------- 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.CO.