8411 - Laserfiche WebLink

Home Browse Search

11oy�vu-.j 1 ,14 APPLICATION FOR ANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued gA plical-ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. 's application is made in compliance with Count Ordinance No. 549. 4f ; r inance JOB ADDRESS AND LOCATION '7d. I ..... .. --------- ........ Phonele !P- _--_1-- -—----------- ------------••-------------------------------- Owner's -------------------------1----------------- Owner's Name---.--- ----------- Address--------- A,& ----------------------1-1-----------------------------------------------I---------------------------I------ --------------------------------------------- Contractor's Name-------7:x_)-fa<; -_Q-----11---11-1 --------- ------------------------------------------------------------------------- -------------------- Phone-4-kf Installation will serve: Residence NApartment House [] Commercial 0 Trailer Court 0 Mjfej E] Other ❑ r . Number of living units; _j----- Number of bedrooms -1-r. Number of baths ""_L""- Lot size _---- 61C.'r Water Supply: Public system Ej Community system El Private 'Depth to.Wafer Table &ft. Character of soil to a depth of 3 feet: Sand []I Gravel E] Sandy Loam El Clay Loam L] Clay [] Adobe[Hardpan ❑ Previous Application Made: Yes EI No ErN;w Construction: Yes [�No L] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Ta Distance from nearest well-----------------Distance from foundation___".-_____.____- Material_____________________ No, of compartments-------- --------- -------------- --- ---------Size--------------_--------------.-Liquid depjh------------- -------------Capacity-------------:------------- Disposal Distance from nearest welf-----------------Distance'from foundation--------------------Distance to nearest lot line-"__ "-"-_____. I � Number of lines___._--_ ----- ------- -----------Length of each line----- --- ------------ -------Width of trench----•---------------- ------------- Type -of' filter matpr.ial-,-----------------------Depth of filter rnaferial----------------------Total length_-___"_-_"_---____.__--__-------------- Seepa�vcf: Distance to nearest well 3_0��........Distance from founclafion-4,�-4--.Dislance to'niaar,sj��be_,4,qf . �e Number of pits-----I----------------Linin' maferial-A----___.___Size: Diameter--. 9 30.... Depth.-..-q_ Cesspool:- Distance from nearest well-----------V---Distance from foundation.__-..._____._. . El S;ze: Diameter-------------------------- ------�i----Depth-------------------- _Lining material__-.___..___.-_____.___• Disfance from nearest well--- ----------- --------------------Liquid Capacity----------------------------gals. ------- --------------------------------------Distance from nearest building."--_______".----___--_ ----- Distance to nearest lot line._.- ------------------------------------------------------------------------------------------ ---------------------------- Remodeling and/or repairifig (describe):--- -i--------- k --- ------- ----------< - ------------------------ ----------I——-----------------------------------------------------------I---------- :----*--------------Z�l------------------------------_j------------I-------------------- -------------0------------------------- --------------------------I-------------------- 4, -------------------------------------------------------------------------7----------------- ----------------I-----------------------I------------------------ --------------- ---------------------- -------------- --------------------- •------- -- - ----- -- -- ---- -- -- -------- ---- ------ ------ - --- ------ I hereby certify that I have prepared this application and that the work--will--b-e--ld-o-ne--in-'accord-a-n-ce--wifh--San--J,oa-quin---C,o-u,nty, .f ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) ------- ------- ------ - --------------------------------------------------------------------------------- ........(Owner and/or Contractor) By:--------- I - 0 ------ ------t^j. % U� *fle)-- ----------------- ----- ------ ....... ------------- --------------------------------------------------- .-(Ti i size ... ...... . ,n, showing s -(Plot plan, showing size lot, location of system in relation to wells, buildings, etc.,.can be placed on reverse side). 4 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- --------------- --- DATE REVIEWED BY--------------------------------------------- --------- ------- .................. .................. DATE BUILDING PERMIT ISSUED . .1 P -------a-—---------------------------- . _�T I _----------- DATE_ A"'e' ns aDj or recomcnendAfions:-4.,...ci V_... A_------------------------- ------------------ -----------a,e_ (;4�------ - ------ --- ----- ----------- 7------------------------------ - --------------------------------------------------------------- -- --------------- ------------ ------ -------------- -------------------------------- r ..... ------- - --------------------------------------------------------------------- ------- ----------------------------------------------------------------------- ---------------__------------------------------- ------------- - -------- --------------------------------------------------------I__------------------------------------------------------------------------- ------------I---------------------------------------------------------------- ----------------------------- ------------- FINAL`'INSPECTION BY:--------i ------------------------------- Date------ --- ----------------------1. ---- SAN JOAQUIN LOCAL HEALTH DISTRICT % 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca,-California Tracy, California ES-9 145446 ATWOOD