10387 - Laserfiche WebLink

Home Browse Search

r APPLICATION FOR NITATION PERMIT Permit No. m (Complete in Duplicate) '.` I Date Issued f ' Application is hereby made to the San Joaquin Local Health District'for a permit to construct and install the work herein described. his application is made in compliance with County Ordinanc No. 5 9. ' JOB ADDRESS AND LOCATION----- a --_ I PhonOwner's Name--------- -------- _ - Address......11-3-.1- ------ -- - lq •-- ---S ---- -------------- -- --------------------------------------------------------- -------------------- -- ` Contractors Name---------- F c - ------ ----- -----* �v--- r Phone *j-�Q- ---- Installation will serve: Residence gI Apartment House"0 Commercial [I Trailer Court [I Motel ❑ Other ❑ Number of living units: j--- Number of bedrooms ____L Number of baths __L Lot size ____�J ---___________________________ Water Supply: Public system M Coo rnunity system 'p❑ Private ❑ b epth to Water Table 3d ft. Character of soil to a depth of 3 fee+: Sand ❑ Gra�v�l ElSandy Loam ❑ Clay Loam ❑ '`Clay ❑ Adobe IN Hardpan ❑ I Previous Application Made: Yes ❑ No ,—New Construction: Yes © No ❑ FHA/VA: Yes E] No El TYPE OF INSTALLATION AND SPECIFICATIONS: ` p ' p p gyp.a 6lic sewer is a 'it n-200 feet.) i t, iLs r � Septic Tankse tic tank Distancefromnearest permitted ______Distance_ ;. + +: otic ----.Mafe,'al 4- r N��'ofFcompartments'`'-4'-- 5�''`rk �h xquid c1""��th_ �'1�, .. apaci#Y 4 ------------ Disposal •- - --- Disposal Field: Distance from nearest well._l4�_/_Distance from foundation ___ _____Distance to nearest lot line.-ab__.._.-:__. Number of lines__________________ )De 9h eah lne___-_____ `�f____-_.Width of trench____ ~"'per �_Len th o Type of-filter material-__:_____. p f filter material___.__� ____ ____Total length------------- '------------- ------------- Seepage Pit: Distance to nearest- well___1ap------�_Dist��e fro"`�m f Aundation .Dis#a��e to nearest lot line��d------- Number of pits_____.__�____._______Lining material__ ____.Size. Diameter__.__ ..._...___.Deptn_._._.. _ ______________ kCesspool: Distance from near st well_______________ _Dtance from foundation--------------------Lining material---- --- - --------- -------- ----- r ❑ Size: Diameter------------------------------ t ----i-Dep -----�;---------------------------------------Liquid Capacity---------------------------gals. Privy: Distance rom nearest well---____________I------------- �___7�istance from nearest building-------------------------------__.______- t ❑ Distance to nearest lot line- --------- --- ;-, Remodeling and%or r pair n tribe : a. ! c�C 1 - --- f ---4 ✓ .__ 3 X .- S ---------------------------------------- -- -- -- - -- --------------------------------------------- I''� ' ------------------------ ---------------------------- _______�___________________�________________________.______________________ _ ________ ) i� I hereby certify that"I"h vd a prepare`e_ 'tliis appl'rca}ion and thaf-+lie Mork will'be done in accordance with San Joaquin County € ordinances, State laws, and rules and re ulation3 p f'the/San oa uin Local Healt District. -.-. (Owner and/or Contractor)(Si ned)-------------- B ---• f --- Title----- (Plo+ plan, showing size w ot ,locationof system in relation to wells, buildings, etc., can be placed on reverse s' e). FOR DEPARTMENT USE ONLY APPLICATION REVIEWED BY_-ACC TSD BY---------------- ----- /" --:- --•---------------------------------------- DATE------ _- - " DATE_____ BUILDING PERMIT ISSUED----------------------------- --------------------- DATE------------- - Zfionld/or commend ions: t ------- ------- ----- - - -- � --- / ^m'0.• -="------ ----- ----- ---- - .� K--? ----------- I r - �.,,:_)FINAL INSPECTION BY:.------- --------------------------- Date----- r/4i------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South.Arn"erlcan Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revises 1.57 F.P.CO. %