8317 - Laserfiche WebLink

Home Browse Search

V-3 e APPLICATION FOR SANITATION PERMIT Permit No. ..-Q_-_. --�_ ___ (Complete in Duplicate) - Date Issued y._-�/----7- --------- Applica{on is hereby made to the San Joaquin Local Health District for a permit to construct and install th:,-work herein described. This application is made in compliance with County Ordinance . 544. JOB ADDRESS AND OCATION�. ' ,.3-6----- ----- -------------------------- } - ---------------------------•-.------------.--------------.-- Owner's Name---_ 2�Z�/6/ Phone / "� ---------- Address-•------------- � •------------ 1 Contractor's Name--------------- ' - ----- -- --- -- -- ----- Phone -. .-. --` Installation will serve: Residence [yj-`Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .-f---- Number of bedrooms -*Z-. Number of baths --/__ Lot size -_7d_�exe 40.11 Water Supply: Public systeme[ 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[B -Iardpan ❑ Previous Application Made: Yes"❑ No New Construction. Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f • e tics Tank: Distance from nearest well --------------Distance from foundation---_---------------.Material----_------.--_-__-- No. of compartments--- -- --------------- ---Size---------------------------_-'Liquid depth---------- Capacity 1 ------ ------- D,is osa! Field: Distance from nearest well-----------------Distance from foundation---.---------.------Distance to nearest lot line.-----_----..__- Number of lines-----------------------------------Length of each line-------------------------- .Width of french Type of filter material-------------------------Depth of filter material---------------------.-Total length ------------------•------ Seepage Pit- Distance to nearest well O—A44.0-Distance-fJom f undation___Z -----.Distance to nearest lot line-_- Q--�.- Number of pits- --- ------------Lining_mate _Size: Diameter-----3._3 ------Depfh-_--a.S'' m ------ " l 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 and/or repairing (describe):-..-- - ` -------- -------------•------------------------------------------------ -------------------•---------------- ----------------------- -----------------------------••- -------•------•-----------•-• -----------•-----------------•--------- -----------------•---•-------------------•---------- -------------------------------------- -�------- hereb certify that I have _..- Y y prepared this application and that the work will be done" ri accordance with San Joaquin County ordinances, Sta aws, and rules and regulations of the San Joaquin Local Health District. F. � � 1 (Signed) h - - - (Owner and/or Contractor) �. �. By:--------•-•-----------•---- ----- (Title) ------------------ ------- - --------•----------- --------------- P of plan, showing size of lot, location of system i elation to wells buildings, etc., can be placed on reverse side). FOR DEPART ONLY APPLICATION ACCEPTED BY- ---- ----- - ------------------ --- - ------------j----- ------------- - DATE-- ------------•------- -------------------------- IEWED BY-------------------------- ------- 'I--- =- -------------------- - - ----•---------------------------- -------- -- - ._ DATE._------•---- --------------------------------------------- Alterations ---•----•--------- --•- - ----•- BUILDING PERMIT fSSUED----------- ----=-------------- ------------- ------------------------------------- DATE-- ------------ -Alterations and/or recommendations::{ •--J -------••------------- )- -- ---- -----__--.---------------•- -�- ---- --- - - - L.� ..----- ------------------ ---•• ----------------------- -- -- -_-- ----__---. ------------------------------ - FINAL INSPECTION BY:,...... -- - Date....... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Sfreet 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California r es-g 145445 ATWOOD