21529 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ---------------------------- -------------- ----------- `. APPLICATION FOR SANITATION PERMIT -,Permit No. ----- --------------------------------------------- This Permit (Complete in Duplicate) Date'lssued -------------------------------------- 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. t J JOB ADDRESS A CATION _. _ -- ---- - - � Owner's Na "--� ----------•----------- -------------- Phone------------- __ SQ ----------------- ---------------------------•---------- Address ------- ------ --- ------ ------ t Contractor's Name Phone. .. .. Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I____ Number of bedrooms _Num�/Depfb baths __l___ Lot size , "_._ __ __ ------------__________ Water Supply. Publics stem Community system Private to Wa#er Ta61e ________ ft. PP Y� Y ❑ Y Y ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,dote--------------------) No ❑ . New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS.- (No PECIFICATIONS:(No septic tank or cesspool permitted if public sewer is available within 200 fee+.) Septic Tank: Distance from nearest well_________________Distance from foundation-------------------Material_____-.-_-___...--.___._.___-----_._....______- .. Liquid depth--------------- - --------Capacity-------------- -------- D No. of compartments------'-------------------$ize-------------------------------- Disposa eId: Distance from nearest well---Sa_r°._Distance from foundation___1.O_-___.-_.Distance to nearest Iodine_/9_�______ Number of lines_____---/-- Length of each line1_!tU_�____._.-.Width of french.___ �_________________________ „ -Total len th---t- "G Type of filter material____.__ .t-�_!------Depth of filter materiall__ -- g Seepage Pit,: Distance to nearest well----------------------Distance from foundation--------------.____.Distance to nearest lot line---------------- ElNumber of pits------- --------------Lining material.--------------- ---..Size: Diameter---------- --- --------Depth--------------------------------- Cesspool: Distance from nearest well________________ Distance from foundation--------------------Lining material---------------------- ---------------- ❑ Size: Diameter---------------------- ---------------Depth------ ------- ------------------------------------Uqui.d Capacity---------------------------gals. Privy: Distance from nearest well.---------------__ -------------- _ --------------Distance from nearest building___._-.---______------______---._-_------- ❑ Distance..to nearest lot line------ -------------------------------------- ------------------------------------------------ ----------- - 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, an les and regulations of the San Joaquin Local Health District. (Signed) ----------------------------------------------------- ----- and/or Contractor) BY:-------------------- '`-�--- 0 r�J--- ----------------------------------------(Title)---------------------------------------- ------ - -------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_. _---- DATE----- '- _ _�. "G-_- --------------------- REVIEWEDBY--------------------------------- - ------------------------------- --------------- DATE - - ---- - - - - -- BUILDING PERMIT ISSUED------•---------------------- ----------------- DATE. Alterations and/or recommendations:----------- ------ -------------------------------------------•----------------- ------•------------------------------- ------------------------------------ ---------------------------------- --------- ------------------ --------------------------------- ------ ------ ------------------------------------- ------ ------------------- ------------------------------------------------------ ---- / FINAL INSPECTION BY: -------------------- Date... ------ -------- ----------------- - --------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th street Stockton,California Lodi,California Manteca,California Tracy,California t F.P.C C"