18921 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: -- --------------'------- ------------------------------- It , ,"I:��---� APPLICATION FOR SANITATION PERMIT .. �, Permit No. . .. rZ ------------------------------ --- -- -=fie-------------- {Complete in Duplicate) �, Date issued ----------------------- ---------------- ------------------------------- This Permit Expires 1 Yegr-.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 N6. 549. JOBADDRESS AND LOCATION--------------------------------------- ------------------------------------------------------------------------------------------------------------------------- Owner's Name---------------------------------------------------------------------------------------------- - Phone---------------------------- Address-----------------------------------------'----------------------------------•--------------------------------------------------------------------------------------------------------•------------------------ Contractor's Name---------------------- ----------------------------------------------------------_•------------------------------------------------------------- Phone------------ ---------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _..._`_. Number of bedrooms -------- Number of baths -------- Lot size ___________________________________________-__.-__--____-__ Water Supply: Public system ❑ Community system ❑ Private ❑''Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date......... .........I No ❑ 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__________µ_..__Distance from foundation-------------------_Material_ ------------ ------- __-_--------..____.____. ❑ No. of compartments------ -----------------Size--------------------------------Liquid depth---- ------------------:Capacity..-------j'----------- Disposal Field: Distance from nearest well-----------------Distance from foundation---------------------Distance to nearest lot line----------------- F1 Number of lines--------------------.--------------Length of each line-------------------------------Width of trench------------------------- Type of filter material-------------------------Depth of filter material____.___________.__._Total length___.i___________________________________._ 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 ------------- _ .'__-._-__Distance from nearest building_________________________________________ 0 Distance to nearest lot line----- ------------------------------------ ---------------------------------------•------------------------------------------------------- Remodeling and/or repairing {describe) ---------------------------- ------------------------------------------------------------------------------------------------------------ --------------------------- •--------------------------------------------------••-•-•----------- ----------------------------------------- --------- t I hereby certify that I have prepared this application and-fhaf-tke-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 By:-------------------------------------------------------------------------------------------------------------------------------------(Title)--------------------------------- ---- (Plot plan, showing size of fot;-location of s stem in relation'to wells;buildings, etc.,`can be placed'on revdrse side). - - — - - f, FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------------------------------------- � _- ---- DATE. --------------------------- __ _ - REVIEWEDBY------- ----- - ------------------------------ ----------------- ------------------------------------------ DATE------ ---------------------------------------•---••--- --- BUILDING PERMIT ISSUED------------------' - ----------------------=---------- •-- ---- DATE--:--:---:----- ------ ------------- -------------- Alterations and/or recommendations:----- ----- ---------- -------- --------------- -------------------- -------- - ----------------------------------------- • -----------------------------------------------------------------------------------:------------------------------------------------------------------------------ ----------------------------------------------------------- ------------------------------------------------•-----------------------------------------------------------------•--•--------------------------•----------------------•-- --------------- ---------------------------- ------- ----------------------- ------ --------- 2 ------- ------ ------ -- ------- ------- ------ ------------- ----- ----------------------- ------ FINAL INSPECTION BY-- - -------- ---------------------------- --------------------- Date-------------------------------------------------------------------- ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street _ 1a4 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.0 O.