19327 - Laserfiche WebLink

Home Browse Search

F R OFFICE USE: 61 .30 I / ------------------ APPLICATION FOR SANITATION PERMIT Permit No. ..f c�- .-. - . (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 LOC 497__�� 1 q----- Owner's Name----------- ----- � =f---------- ------------------ - - - - - Phone__--- 1f ;----------- ��r'�.gf- ---------------------------- Contractor's Name----------- --•-- ----= �� Phone . _ _. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court [] Mgtel ❑ Other ❑ Number of living units: __/-__ Number of bedrooms __rNumber of baths /_-__ Lot size ____ ------------------- -____________-____ Water Supply: Public system ❑ . Community system ❑ Private C9---[5-epth to Water Table 44-P 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--------------------) No a New Construction: Yes ❑ No [l-- FHA/VA: Yes ❑ No E4— 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__-_______-___Distance from foundation--------------------Material------------___-------___________________________ ❑ No. of compartments-----------------------r-Size---------------------------- ---Liquid depth--------------------------Capacity----------------------- Disposal Field: Distance from nearest well..? ___ _Distance from foundation___ --------Distance to nearest lot lin__/-_ Number of lines____�___________ ____ ________Length of each line__: ________`�_____--Width of`trench.__�_�______--___-_-__ Type of filter_material__/_ -Depth of filter material__/�-- length---------��------------------------ Seepage ------------------See age Pit: Distance Onearest we11__,/z9Q--- _---Distance fro foundation___ 1 ��__ Distance to nearest lot line--,--, Linin material__ 2pP .. ize: Diameter__-___� �f Number of pits g � Depth_._. . Cesspool: Distance from nearest swell_---------------Distance fromjoundation____.--------------Lining material-------------------------------------- El Size: Diameter-- j �-----------Depth----------------------------------------------------Liquid Capacity- - -----------------------gals. Privy: Distance from nearest well-______________ --------------------- ---____Distance from nearest building_____________-________________-_---___. ❑ Distance to nearest lot line-------- ---- -------------------------------- ---------------- -------------- -------------------------------------------------- Remodeling and/or repairing (describe):____-_- '______ -- -- 1� -,. , ---------------------------------------------- --------------------------------------------------------------------------------------•----------------------------------------- -------------•------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------•---------------------------------------------------- ------ ----- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat-Jawsnd 'rules and regulations of the San Joaquin Local Health District. 4 i l ------�.. -(Ow r and/or Contractor) (Signed)-------------------- Title <------------------...----------------- By:-------------- (Title) (Plot plan, showing size of lot, location system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- '`----------------------- ---------------------------------------- DATE------- ' dam ��`? REVIEWED BY----------------------------i - ------- -- ---------------------- --------------= -•---------------------------------------- DATE--------- -- BUILDING PERMIT ISSUED--------------------- ----L•----- ---�- - ---- ------- -- _ DATE-------------------------------- ------------------------- - Alterations and/or recommendations:._.__// �9 ._ __ _------------------------------_ f p t t. FINAL INSPECTION BY:. . --- =--------- -------- ------------ Date--------..... ------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lad!,California Manteca,California Tracy,California F.P.C C7.