21316 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: r �� ""`a_ - ---------------••- ---------------------------- ----- ------ ----- _APPLICATION OR �'ANITATION PERMIT Permit No. (Complete in Duplicate)___ p ) Date issued " ---- - _ 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. � � This application is made in compliance with County Ordinanceo. 549.'r :�. F �7 pts �� DG - -?- ��-------------- -- JOB ADDRESS AN• OCATION _ f� - -------------- - .--- Phone----.---•---------------- . \ ------•---- ,f�� G .c. �J�l ----------------- ------------t----------- -- --------------- Owner's --------- Owner s Name ------ ----------------------------- / �l.r - -1 -<` ------------------------------------------------------------- ------------- Address------------ -------- -------------------- - � 10.1 --------------------------------- Contractor's Name"__-______________ Motel ❑ Other ❑ Installation will serve: Residence Aip%rtment House ❑ Commerc'sa a Trailer Court ❑ Number of living units: __j----- Number of bedrooms _-2- Number of baths 0 ___-___ Lot size -_._-_ ----------------- fft. Water Supply: Public system ❑# Community system Private ❑ Depth to Water Table -C a Adobe❑ Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel Sandy Loam Clay Loam ❑ Y ❑ Previous Application Made: {if yes,date_._------- --------1 No , New Construction: Yes ] No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: No se tic tank or cesspool perrnitte_�d frpubli ails£le.within 200 fe t�) r -- -�,..� -r->� . � � - � �C�--------Mat7a - -- -. � , " sta04 nce,from foundatio�l- ._-____- Septic Tank- Distance from nearest well_.-__- __"_ 1Ca acit �__ -� -- - No, of compartments---------------------- -Size-- - —----- squid depth_ � -- P Y �} Disposal Field: Distance from near it well - ---- _. Dist��ce fromf u�Jnda o�nJ-d --Distance to nearest lot l-- e1�----------- Le `th df each $me Width of trench:--=-Z_�' n �------ ----- - --- 9 r Typetof fiitermate ----Depth of filter material_-�_ -------------Total length--- ------------ Number of lines__. Seepage Pit: Di stance-to nearest'well --._'Linin -Dismal e from foundation Diameter__ Distance to nearest lot line------------ Seepage Dumber of pits._-"-. - g I Cesspool: Distance from nearest well_____ Distance from foundation--------------------Lining material----------------------- ------------ Distance Depth ----- -- ---------- --- ------Liquid Capacity_. ------------------------9 ElPSizer Diameter_ ._ ----------------- �+---• w --" - ' -= - "'„~Distance from nearest building. privyi' "Distance from nearest wel" ___ __ __ __ __ ________ ❑ Distance to nearest lot line"----- -----•-- ---------- --- -------------------;f -�---- - --- - .�-- ��. ` �� Remode� ea /oc repairing��escribe):__.-J !f'�._ L- ----: ---- �� sa -------------------------------- -----------------------------------------------------------------------------------------------•------- ----------------------------- - --- - --- ------ ----------------- --- ication and that } I her e--by- --certify thaaldhave rulesanprep dr egulations olf the San JoaquinhLocalkHeawill ltheDistrictn accordance with San Joaquin County ordinances, State laws, n i - Owner and/or Contractor) ------------ ✓ [i. / "' (Signed) ---------Title ----- ---------- _-. _ x ----- T-_--• plan Flawing size'of lot, locetion-of system in-re o wwells, bullrings;etc•ars be P eced`on reverse sl e�: f FOR DEPARTMENT USE ONLY i. APPLICATION ACCEPTED BY------------------------------------------ ------------------------- DATE ----- ----------- ----------- i REVIEWED BY ------ ------- --- - . ---•---- ez- ---- DATE_------- . w- � f" . DATE 13U I LDING PERMIT 1SSU E -------------------------------- --- --•- -----•----------- ------ Alterations and/or recommendations------------- ....... ------------------ ----------------------- ------- - ------------------ ---------------------------- -------- -------------------------------------• ----------------------------------------- - -- ------------------------- -------•---------------- -. ----------"-----•----------------- ------------ - ----- ---- -- ; 5)d -- ---- Date------ ------- --- -- -- - ---------"-- ----------------------------------- FINAL INSPECTION ---- ----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 sycamore Street 205 West 9th Street Lodi,California Manteca,California Tracy,California Stockton,California '°'�"`~`-'v F.P.C C.