Laserfiche WebLink
FOR OFFICE USE: i \ <br />------- ---------------=----------------- -------------- <br /> 'APPLICATION RANo. <br /> NITATION Pr�RMIT Permit <br />---------------------------------------- --- I (Complete in Duplicate) <br />---- ------------ -------------- � This Permit Expires 1 Year From Date Issued <br /> Date Issued...----lG.. .� <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. 2-12 (Qw?rl3 <br /> JOB ADDRESS AND CA ION_-_ * �c. j <br /> Y <br /> Owner's Name--••-r--- ------ ---------°__ �_...�-�--•�:.��� --� ---------------• -------------- Phone...----------------- <br /> _._...------- - <br /> Address � } - - ------- - � "rG - -----------------------------•------. --------------------------------------------------------------- <br /> Contractor's Name_------------------11. . --•-------... .._ - ----------- <br /> ------------•-------- Phone---- -------------- - <br /> Installation will serve: ResidencFe ❑ Apo ant House ❑ Commercial E] Trailer Court [I Motel E] Other []...�. <br /> Number of living units: '�------ Number of bedrooms -------- Number of baths -------- Lot size ------- -' <br /> Water Supply: Public system �❑ Community system ❑ Private K Depth to Water Table -cJft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> �i <br /> Previous Application Made: (If yes,date....................) No 5A, New Construction: Yes4-No ❑ FHA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cessp1.ool permitted if public sewer is available within 200 feet.) <br /> Sep i Tank: Qistance from nearest wall:r�Z.a�'-_�`-Distance from foundation_.._ _ -77.Mate�i"L`=. ..............::....... <br /> NoVil . of compartments.-.!1....._. :..Size .. . -quid dapth..._....-. ------...Capacity„. 2-� .__ <br /> P 1 ) <br /> ilium nearest welL..�,.8�...Distance from foundation.,-�.�..-. Dista ce�i nea est lot line__,.(?... <br /> Disposal Field: Numbee ofd.lines.. _ Length of each line�' ..1 _. _ .-0 of rent ..--------�-_3l �f ....._.. <br /> Depth of filter materials r...,'Total length-------- .__ .............. <br /> Type of filter material.*7t _V_ --._ <br /> Seepage Pit: Distance to nearest'well----------------------Distance from foundation____._..-_--_--___.Distance to nearest lot line...-__-...._...._ <br /> ❑ Number of pits----------------------Lining material---------•-------------Size: Diameter-----------------------Depth-----------------•--------------- <br /> i <br /> Cesspool: Distance from nearest well................'Distance from foundation--------------------Lining material....._......-.._...._............_.-. i <br /> Size: Diameter------ -- - _-------Depth.;----------------------------------------- <br /> --------Liquid Capacity_: <br /> .�..,T. ^,.:t.-FT Y _..__--; -n. <br /> LAP <br /> Priv Distance from nearest well--------------------------------------------------. Distance from nearest building--- ----------------------------------- <br /> . . -. -. _ - --------------------••---------------------------------- <br /> Remodeling <br /> ---------- ------------•-------- N <br /> Distance to nearest lot�line------------------------------------------------•------•------------------•--------... �•1- <br /> �. <br /> Re odeling and/or repairin (des ribe):--j-Psi...... ,-- +- - 1► --- r' '--- tTe ; - st t x -•---•••- <br /> ' -- - <br /> ......_.-- --- ------------------------•--------------------------------------•--•---- <br /> - <br /> --7 <br /> a -•--•-=-----------------------------------------------•-••---------------- <br /> hereby certify that I have prepared this-application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed-------- ---- .ri..x - "_--` '-------------------------------------- -----------------------------------------{Owner and/or Contractor) <br /> r g ti (Title)----------------------------------------------------------------- <br /> i Y• -- ------------ <br /> (Plotrplanl<.5howing size of lot,„locaflon of system..in`relation.to wells„_huildings-etc., can_be_,placed an reverse side): <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY-------------------------- ----------------------------- ------------- DATE--------------•-------------------------------------------- <br /> REVIEWED BY _ - DATE- ------- <br /> cmr <br /> BUILDING PERMIT ISSUED--_---------------------- ----------- - -------- - DATE <br /> Alterationsand/or recommendations:-------•-- -----•------------------ -------- - -----------------------------------------------------------------­­ ----------.:------ -----_------ <br /> il <br /> 11 <br /> i” <br /> I! <br /> FINAL INSPECTION BY:--- ---------- ------- Date-------------_--- --'---------------..----- <br /> IiI <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California ''r Lodi,California Manteca,California Tracy,California <br /> ES-9 REVISED 8-59 F.F.CO.SM 6-60 .i <br />