19151 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: - - ----------------------------------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ___.).. ..r.s•_I„ -------------------- ---------- ------------ --------- - (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 made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION---------- 4901 -- d - Owner's Name------ ------- - ---- - . --------------- ----- Phone.. Contractor's Name -- 7 ------- •----- -.---- -------------------------------------------------------------- Phone--------- - -- -- - - - Installation will serve: Residence ] partment House ❑ Commercial [] Trailer Court [❑ Motel ❑ Other ❑ ' Number of living units: I------ Number of bedrooms ._13'-_ Number of baths __1---- Lot size __,6_Z_, X---/Z�-------------------------- Water Supply: Public system ommunity system ❑ Private ❑ Depth to Water Table -------- ff. Character of soil to a depth of 3 feet: Sand ElGravel ❑ Sandy Loam E] Clay Loam EJClay ❑ Adobe ®-119ardpan ❑ Previous Application Made: (If yes,date--------------------] No 91�_ew Construction: Yes / No Elfir] FHA VA: Yes 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_WZW--e-Disfiance from foundafion__.Ld-`__.._._ Material----1 No. of compartments----- --S-----------------Size--- ---------Liquid depth--------.y--- ---- -..Capacity--.��Q---------- Disposal Feld: Distance from nearest well--yV!) -----Distance from foundation-__.L!?............Distance to nearest lot line.---�t��r-- ©/ ---------- Number of lines----------- �-------®- Length of each line_--_____ �-----------Width of french.___-;t, V-----__--_-__ T e of filter materiaI__,7 -_ ---_ - l Yp F��+-- ___--___Depth of fiifier material___7�--__---____-Total length_--.___/_fZ2------- ---------------- Seepage Pit: Distance to nearest well---N¢ ----Distance from joundafion---1_0 -------.Distance to nearest lot line-----+4 �-.._ ❑ Number of pits._2— Lining material._ _ .___---Size: Diameter-_._�- -`------- Depth__---..__�_ �-_-____-- Cesspool. Distance from nearest well-----------------Distance from foundation------------------- Lining material------------ ----------- ❑ Size: Diameter. ----------Depth------------------------------------ ---------------Liquid Capacity--------------- __gals!d Privy: Distance from nearest well------------------------------_---------_-------Distance from nearest building7 ❑ Distance to nearest-lot line------ ------ ---------=------ ----------- ----------------- ------------------------------ ------------------------------------------- Remodeling and/or repairing (describe)__________________ ------------------------------------------------------•--------- ------------------------------- ------------------------------------------------------------------------------------------------------------ - --------------------------------------------- --------------- ---- j I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County I ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)+_________ ............. By:. (Owner and/or Contractor) - Tale -------------- (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 BYDATE I REVIEWED BY -------- ------ DATE ' BUILDING PERMIT ISSUED--------------------------- --- ------------ - ------------------------------------------ -------------------------------------- DATE.---------- -------- Alterations and/or recommendations:_____.___._ --------- --------------------------------------------- -- - - �.. -- ---------------- - ---------------- ----------------------------------------- ------- ---- - ----------------- ------------------------- ---------=----------------- ---------�-_4--- --- ---------------- ---------- FINAL INSPECTION BY:. --- ------------------------------------ ------------- Date------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street i 24 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy, California