8794 - Laserfiche WebLink

Home Browse Search

APPLICATION. FCC ANITATI .PERM Permit -- j ` v �� 6oI0 ` Complete in Duplicate) �0 7 #JAS Da#e Issued - ------�s �1or Ij � 3.8'3 6/�f L , - Applica+ion is hereby mnadQ to the San Joaquin Local Health District four a permit to cons ruct and install the work herein described. r� This application is made in compliance with Count rdinance No j JOB.ADDRESS AND ATION_. __ � �--fit G� -------------------- ------ - w ; 3 Phone Owners Name--- �' •- ---------- Address._..� y...... _ - i Contractar s Name___ -�� ' Phone .. _ss•..__,r!_ ,,�'�-- - Apartment House ❑ Commercial ❑ kTrailer Court Motel Other.[3- Installation will serve: Residence ❑ Number of living units: _I--- Number of bedrooms .1 -. Number of baths - Lot size ____,.___.-`_ ��' ` �- f-------------- i. Water Supply: Public system ❑'—C&nr unity system ❑ Priva+ek• Depth"+o Water Tablel� ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ `Clay ❑ Adobe Iky Hardpan ❑ Previous Application Made: Yes ❑ NoX New Construction: YesX No ❑ y 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--------------------- .________-__.._._.__-.._. { e No. of compartments---------- - -------------Size------•-----------------•-------Liquid depth----------- --------------Capacity---------•----------- Q Dis os l field: Distance from nearest well.................Distance from foundation--_.____._____--__.Distance to nearest lot line-_______---_-____ {� r Nuinbar of lines Length of each line Width of french------------------- ------------" Type of filter material-------------------------Depth of filter material-------------- ---Total length-----------------------.----------------- . 5eepa it: Distance to nearest well f4____- --__Distance from bundation a�_ :_Distance to nearest lot line � r1 { Number of pits.__._--- ------- Lining material _-- - �------.Size: Dia eter----r'C� ---------.Depth.----, ,r7�---- ----------- _________Distance from foundation__._-----________..Lining material.----_-...____._____._-----.__.' Cesspool- Distance from nearest well________ ❑ Size; Diameter------ ------------ ------------------Depth---------------`----------------------------- Capacity - ---------------- ---------- Privy: Distance from nearest well________________________ _ _--I-_.-Distance from nearestlbuildin ---- ---------- El .__ a s. tl ❑ Distance to rsearest lot line.------- ------------------------------------------------ , -- - # remodeling and/or repairing (describe)-----. � .' r .. __.. ------------------------------------------------------- --- /-, v ---------------------�„ -------------- ---- ---•-- ------ - -------- -� - ----- ---------------------------------------------------------------------------------------------- I hereby ch 4 have prepared this application and tha ,the work will be done in accordance with San Joaquin County ordinances, State laws, and rule a . r_egulatio :f the an Jo uin Local Health District. �A Aw -------- - . . ---`�i---' ,[Owner acrd/or Contractor` (Signed)--- = r _ /... `�erse !� : - --:--- ---- -- {Ti+lei' - By:--------- , (plot plan,-shoving size o ot, location of system in relation to wells, buildings, etc., can be placed on r e). k FOR DEPARTMENT USE ONLY ! r APPLICATION ACCEPTED BY--------------------- --------- --------------------------------- ------------------------------ DATE-------- ---2------------------------- ! REVIEWEDBY------ ----------------- --------- --------- DATE-- --------------------------------- ---- ---=-------------------------------------------------- --- DATE ----------- BUILDING PERMIT ISSUED------------------------- --- -------- - r. . t _ .-.,..,. ------- ------- ----- --- ---------------- Alterations and/or recommendations:__ - ---- ------ T / :J ---------------------- --------------------------------- a;.: _. ------------------ _--- -- ----------------- ----------------------------------- ------------------------ ------------- = ...... -----•------�------------- --------------- -----------•-----••--- --------------- --------- Date INSPECTION_BY:... - --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--V-2M 145446 AIWOOD k12-54 ..