17662 - Laserfiche WebLink

Home Browse Search

F R OFFICE USE: Permi a..... _ APPLICATION FO:R ,kNRTATION PERMIT -------------------------------------- (Complete in Duplicate) Date 06 -------------------------- 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 wdescribed. E This application is made in compliance with County Ordinance No. 549. , i • JOB ADDRESS AND TION S -S fi. � 1 i� Owners Name -r------ - --------------- - Phone�'� � / �� ---- ----- �1 Address--------------------•------------_---------- 1•-----u ----`- , -G�-------------------------- ------ --------------------------- -• --------- q Contractor's Name -•"__. -fi�-�` --- - - •--,- --- / Phone..F. I Installation will serve: Residence Apartment House ❑ Co ercial ❑ Tr 'er Court ❑ Motel ❑ Other ❑ Number of living units: __�___. umber of bedrooms Number of baths _____V Lot size ------ ._________ I Wate Supplyi-Public system Community system ❑ Private ❑ Depth to Water Table l `#t. Character of soil'to a depth of 3 feet: Sand ❑ Gravel FlaSandy Loam 0l ".0 y Loam ❑ Clay ❑ Adobe CT'�Hardpan-' ---�, I Previous Application Made: (If yes,date--------------------1 No New Construction: Yes Er NO-'E] FHA/VA- Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: - qX"/.2��x6vW (No septic +ank or cesspool permitted if public"sewer. is`available within 200 feet.)r Septic Tank: Distanee from nearest well__ ._C1kGt__,_Dis}ante fro fo d'' on__._,C-U__ _. Zr-P� No. of compartments---------- .�L�c�uid e -_ �____Capacity._.._C?_. r ,3' 1' Disposal Field: Distance from nearest well----'1d�__Distance from fouridation....f6_n#-----Distance to nearest lot ( Nu"mber of lines------------------ -------- 'Length of each line-----------------------------f -55 '' .Width of trench______ _______ - --.---_--.- �.Y tea. Type of filter materia . ,Aepth,ofIfilter,material_.-=19-_..........Total length---__-__--1_Q______ _____________ e/ T-'- Seepa Pit: Distance to nearest.w I -__--Distance from foundation-----f _t___.Distance to nearest lot line------- .. Number of pits.------- --------Lining material--- p r -----Size: Diameter_-----' -��-'--------Dept ---- Cesspool: Distance from nearest well----------------Distance from foundation------------------Lining material_---------------------------------- 171 -.-------------.----.----- ----_❑ Size:'Diameter----------------------------------- Depth---------_---------- ........ Liquid Capacity------------------------- gals. r Privy: 11 Distance from nearest well.............................:........ ........Distance froth nearest building-- _-____---_---_-___---__---_�...-. V)❑ Distance to nearest lot line--------------------------- ----------------- ------------------ ------- Remodeling and/or repairing (describe)------------------ --- ' � ' * ' )-- ---------•---------------------------- ---------------------•-------=------------------ - --------------- --•---------------- --•--------------------------------------------------------------------------------•- -•• -------------- -•----------------- ------------•---- --------------------------------------- ------------•----- M-----------------------------------------------:- •------------------------•------•-----•-•--- ----•--------------------------------------- _ •------------------ --- - -- I hereby certify that I 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. i a � (Si ned) � ' - ----- ---- (Owner and/or Contractor rT By=-------------------•.-•------_- Y---------------------------------------------------------------------- ----- ----- ' (Title}--,--- - ----------- -------- --------------------------------- (Plot plan, showing.size of lot, location of system in relation to wells, buildings, etc.,,tan be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- - - -- sur ------------ ------------------------------ DATE -T �7� 1 Q-T- -�- ' - - ' REVIEWEDBY----------------------- ------- ----- ------------------------------------------ DATE----- ---------------- ----------------- k BUILDING PERMIT ISSUED,---------------- ------------------------------------ --- -'--- ------•---------- DATE---- - ------------------------------------------------- Alterationsand/or recommendations:--------------/----------------------------- ----------------------------------------------------------------------------- I--------•-------' ------ ------------- ---- ---------------7- --- --------A a--- ------ -._..-- ._------`----------------------•_.---__-___--_---.#-_------.-_.----------------.---•---_------------"I-----_--_-__----.---._--- ..1 _ n -------------- -----i-------------- ----------•--- --------------- ------------�7r747- ,1/ -,- - --•-- . . r. :- -``--, .� __�__. . r�----•--�`'��' ----------- ------------ ------- : `� ti -----------------=---------------------- -- -- ----------- k FINAL INSPECTION BY: GQ'---- _.------------' � "� 'Date--- ----------------------------- -- ---- --------- I SAN JOAQUIN LOCAL-HEALTH DISTRICT 1801 E.Hazellbn Ave. 300 West Oak Street _ 124 Sycamore Street- 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E6 9 REVISED 5-59 3M 3-•63 F.P.CD. art+"