17229 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: --- --------- -- --- -- --------- -- -- ------------------ APPLICATION POR SANITA ON PE MIT Permit No. .____-- ----------- ----------- -------1:1-M------------ ---. , (Complete in Duplicate) _ '' _ - Date Issued ... . __"_-,------_-------------------,------------- This Permit Ex -res 1 Year From Date issued 7�40-. ',7�W 4230--c 1 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. l' � $ ��C1 �. �. r # 3dQkSRr . '�'Zp w -- JOB ADDRESS AND LOCATION----------- -` = - �� r -- --- - ` f j rte. Owner's Name------ -------------- ------------------------- - = J p ._( _E'r"Sd)� *. Phone. /T �Q Address__._k �' .. . �. lZ__ = ---• --."------------- Contractor's Name------------ --------------� h ------ Phone ..... y' _ i Installation',wiil serve: Residence Apartment House ❑ 'Commercial ❑ Trai r.Court ❑ tel fQther ❑ Number of living units: __.1___ Number of bedrooms .� Number of baths ___ "- Lot size'__ __ ______ ___ _________ - + r Water Supply: -Public system ❑ „Community system ❑ Private to Water Table I . ft. Character oE] ElElE] E]f soil to a depth of 3 feet: Sand Gravel Sandy Loam Clay Loam Clay Adobeardpan ❑ a # No [�` Previous Application Made: (If yes,date--.__-_------------1 No W( New Construction: Yes �o [IFHA/VA: Yes ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (Noiseptic tank or cesspool permitted if publicAewer is available within 200 feet.) Di to o fPu�dat'on----- ��}} -t- rC 4�- Septic Tank: i Distance from nearest wa �(1_________.Matenal !-"_________ _______ £ No. of compartments---- - �� Liquid depth----- ----- --------- -Ca skit f S. e of P Yrt 6--- A Disposal Field: , Distance from nearest well--- __---Distance from foundation ."lam _'____?Distance to nearest lot line___ ! Number of lines_______ ______-.. Length of each line � __0 -_!w2-0--Width of trench_----- `- Type-of filter material_ _Depth of filter,material---------1_q___.-__Total length______ "- f Seepage Pif: Distance to nearest well----------------_1- Distance from foundation--------------_____.Distance to nearest lot line_____________.__ ❑ # Number of its----------------------Lin in`material-------------- --_--...Size: Diameter--- ---- Depth ------------------- - p t nearest well__________-__.._Distance'from foundation...--._.___.__.-___.Lining material___.___.__.__.--T___.__---------- Liquid ________a/'� I Li uid Ca ,acit # 1 f ------------ Cesspool. # SizeDists D amet'er"`----------------------- j 'Qepth r?------ -------------'-------------------------- Privy: --------- ---------- q f? Y gals i .-• - ___Distance.,from nearest building ----------- 7 Privy: �t` Distance,from��nearest well---f-----------'---------------- E:] - �'-"--------- ,g-------------------------•------- ---'� f Distariee to'nearest'lotTli�e:j. ----- -------- ----- ------------------ - Remodeling and/or repairing (describe): ! ' ---.-•--- ---•------------------••------fi-----------------------• z 1 r 1 4- <3,.,1. ---------- ------------- J --------------------•-----_ -•----------------- -- --- rL ' ' ------------------ T ------•------------------------------------- ----------------------------------------------- - --------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances,,State ws and rules and regulations.:of the San Joaquin Local Health District. I (Owner and/or Contractor (Signed) - - ---- L}. ------ �.- ------ ;.,� -: ------------------------------------------wells, buildings, etc Title g ' ------- ' ' ------ By:-----------------------------it ' ----- " ----- (Plot plan, showing siz of lot, location of system iIn relation to r, can be placed on reverse side). J FOR DEPARTMENT USE ONLYi APPLICATION ACCEPTED BY------- * �_��'_ DATE------------- �--" ""- -.---------- ---------- REVIEWED BY ................esti DATE------------- F' - ----- DATE----------------"------------- BUILDING PERMIT ISSUED = xX--_--- �::;K.` m r- --------------- � . _ ,...�_...- .,.. _-- Alterations and/or ec mo me dat-o s:_____. -" = "-""""-""'------- - ., .r - �- -4- - 03 r - . 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 Lodi,California Manteca,California Tracy,California ES 9 REVISED 5-59 3M 3-'63 F.P.100,