21014 - Laserfiche WebLink

Home Browse Search

FOR�FFICE USE: � APPLICATION .FOR SAy.ITATI9N PERMIT Permit No. . (Complete in Duplicate) Date Issued ------------ _.- -.--_ - _- � This Permit Expires 1 Year From Date Issue 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. -.._..---- - ------------------------ JOB ADDRESS AND OCAT ON----.--- -- Owners Name-------- - ----- ------ Ph Address-------------------•----------------� '" - -- -- - -. - /► _-.. Phone-=�-�-�-� Contractor's Name------"--- ._.." Gt- 1fz�inT-- •F �. --,t7' �- r Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court Mote! 4 Other ❑ Number of living unit :--�r. Number of bedrooms Number of baths 4-- Lot size _--- I��._ --. 11------------------ Water Supply: Public system ❑ Community system ❑ Private ;�' Depth to Water Table _eo-Ift. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe, ' Hardpan ❑ ❑ No OrPrevious Application Made: (if yes,date--------------------) No 0 New Construction: Yes PC No E] FHA/VA: Yes A# TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic'te k-or cesspool permitted if public sewer is available within 200.feet.)` Septic Tank-' 'Distance from nearest well--- d...-_Distance from foundation-W----.__----.Material-._-_" ( No. of compartments-------- ------"--- Size-- a� X ------Liquid depth--- -----------------Capauty--COQ G L � t I Disposal Field: Distance from nearest well..._/..._Distance from foundation--/P-..----....Distance to nearest lot line_.-._.._". ♦ ioe r' a Number of lines--------- ---------- ----Length of each line--------- Q_� --------Width of trench---r -r- E Type of filter material---Ro-C�----Depth'of..filter material- 19-------------Total length ------------ Seepage Pite Distance to nearest.weli__106..._."-..Distance from foundation--10--------_.Distance to nearest lot line" -------.- V1 Number of its.---- _ .Linin material---/�a Gk----Size: Diameter-__;7__7--��---- .Depth----s>Z�.5-------------------- p ante from foundation------------------- Lining material--..______---------.._---.-..-------- �. Cesspool Distance from nearest weld - Di Depth -Liquid Capacity--------------------------•-gals. (b E � Size: Diameter-----------------........ ...........De Distance from nearest building. r Brivy:� � - Distance from nearest well------------------ ------------ ---- 9- -------------- ------------- ---... .� ❑ Distance to nearest lot line--------- ------------ ------------------"- -------------- ------------------------------- -------------- C/ Remodeling and/or repairing [describe]:_ - ---------------------•------------------•- ------------------------------------------------------ ---------------- j ---•--------"--------------------------------------------- ------------------------------------------------------------------------------- ------------------- ---- -------------------"--------------------------------- --------------------------------------- _ _ ---- -- ----- ------------------------------------------------------------------------------•-------------- -------------------------------------------------------------- I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. Contractor) ` ;{Ssgnr3d}----- -------- -- - -- - -------------- ----- ----- (Ownerr ------------••-- - and/or ' Title - (Plot plan, showing size of lot, location of sy em in re do to wells, buildings, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY 7 � . APPLICATION ACCEPTED 13Y DATE . - , - ----------------------- fREVIEWED BY----- ------------------ ---------- - ------- ----•- ------ ------- ------------ -------------------------- = -- DATE BUILDING PERMIT ISSUED----------------------------------- --------- --------------- RATE Alterations and/or recommendations:.... . --------/ ----- •---- ------ --- ...... t - ---------- C ,- 1 F '� dC ---------------- - I --------------------------- --------------------------------------------------------------------------------------------------- � jj -------f�_ Date.... ---- - FINAL INSPECTION BY---------------- --------- i SA JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazallon Ave. 300 est Oak Street 124 Sycamore Street 205 West 9th Street Y Stockton,California Lodi,California Manteca,California Tracy,California r