21532 - Laserfiche WebLink

Home Browse Search

,+ FOR OFFICE USE: 124A-1 -2 v i� ____------------------------_---------------------- ----- j�„ -----. APPLICATION FOR NITATION PERMIT Permit Na. ------------------------- ------------------------ (Corn plate'in,Duplicate) Date Issued ____ __�J _ ___ ___ - This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. 'r This application is made in compliance with County Ordinance No. 549. w -----------•--•------------------------- JOB ADDRESS AND LOCATION�---------------1_►i-.- ---- ---�if`__ J_!�-_k-�l--/tlL�l----------------------- ------- _ Owner's Name--------1"TJ---------I/ 2 s+.ST f�S__ Ce�f u-t.h. --- -- Address 1.96-=0---CA-e--M<:2,/ e.------- `--------------------- - Contractor's Name----------?� 1/lPl f�/✓ _ Y/ .G. Phone j/cXe•� Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [� Number of living units: _______ Number of bedrooms -------- Number of baths -------- Lot size ........ ` �.�L --------------------------- Water Supply: Public system ❑ 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 M—Tlardpan ❑ A Previous Application Made: (If yes,date_3.-;;��4%�'--) No ❑ New Construction: Yes 91"'N'o ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: t (No septic tank or cesspool permitted if.pu.6.1ic.sevrer is available within 200 feet.) Septic Ta Distance from nearesr welL_______--------Dlstance from foundation Material---- CYG _Ade �� No. of compartments---------------------.-,.-Size-------------------------------Liquid depth--------------------------Capacity--J;p(_ �W 14 Disposal Field: Distance from nearest well..._." ___._._._Distance-from foundation__- __.__.Distance to nearest lot Number of lines_A----------5___..'�-:, Length,.of-each lini�_l 9ZP_/'9X'--.Width of trench..... ------------------ \` Type of filter m/terial X41 Depth of filter material ___../?/`-------Total length-------- _______________________ Seepage Pit: Distance to nearest we€I.._._..'`,p__._.D.istance_fro` u dation____` _____Distance to nearest lot line__._!._.- [ � Number of pits'__-__ ___7___Lining material, Size: Diameter' �,l� �Depth----... _______________ Cesspool: Distance from aFes+well __ _ __": _Distance from foundation.__-------------- .Lining material_____________________________________ _ [] Size: Diameter w . er�ti? r e. --------------- ".' - Liquid Capacity gals. Privy: Distance from nearest well_____________________________ _________________Distance from nearest building...._____.________________ ❑ Distance to near est '- ------ --------------------------------------------=------------------------ ------------------ k . Remodeling and/or repairing ldescribe}== ` -------------------------------------- a ----------------------------------------•--------------------------=---------------------------------------- --------------------------------------------------------------------- _-------------------------------._--_-________ r_______-______--___________________----_________--------------------------------------------..-------------------------------------------.----------------- ..._ „r I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State'ia s, and rules and regulations.of the,San Joa,quin,Local Health District. (Signed) - ------- - -- (Owner and/or Contractor) BY= --------------------------- ---------------- By: --------------- - (Title)-------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). A � , FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED ---—------------------------------------------------------- DATE- r ---------------- -- REVIEWEDBY------------------------------------- ----------- -------------------------------------------------------- -.----- -----. DATE BUILDINGPERMIT ISSUED-----------------------------------------------------------=---------------------------------------- DATE----------------------------------- ----------------•-------- i Alterations and/or recommendations---------------_ ------ --------- - ----------------------- --------------------------------- --------------••--------- �f-�.-G 7 l.- _ � -f �� -- ----- -------------------------- -------------------------- - -------------- --------------------------- ----•- --------------------- --- -- ------------------------- FINAL INSPECTION BY:-------1�`r....��-_..--G/ ------------ Date---- ------y----- ---------- - ----------------------------- J f f SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California iodi, California Manteca,California Tracy,California F.P.CO.