17400 - Laserfiche WebLink

Home Browse Search

FOR OFFICEXS�, --------------------------------------------------------- APPLICATION LZR__��'Mff & PERMIT Permit No. -----------------=---------- ----------------- ---- - (Complete in Duplicate) Date Issued -- . f -----------------------------_..__---______-_.._-__- -. 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 i�ai the work herein described. ,l This application is made incompliance with County Ordinance No. 549. 5 JOB ADDRESS AND LOCAT N--------- ----� -------------------------- 1tZ L1lf © , Owner's Name 1�-ht -• C?N �' - _ - Phone Address------------P: _.:---(30(.. ----�3 --r------- ---------------- - ------------------------------------- - ---------------------- Contractor's Name E •----•-----------••----•------•---------------------` fi J Phone. - Installation will serve: `Residence Ir Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ umber of bedrooms _ _ g ----- --- Number of'baths f--2_—Lot size _1�e'0__X l_0 Q---------------------------- .....: ... _ _ r Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table _l�_ft. Character of soil to a depth~of 3 feet: Sand Gravel ❑ Sandy�Loam ❑ Clay Loam ❑ . CIayI❑ Adobe❑ Hardpan ❑ Previous Application Made:[Ifyes,dat """I No FHA/VA: Yes P9/No ❑ TYPE OF INSTALLATION AICD SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) --� � _... - Se tic Tank: p Distance. from nearest well �� .Distance from fours ation_-__ - ____ __--M' It"eQN----------------------------------- No. of compartments_-_-_Z ----- _._.Sizex-3_k_�__�?_�'_�_JLiquid depth.... _---.Capacity... Y a ... Disposal Field: Distance f om nearest well_<W-'-.,D stance from foundation------__t_-____----Di t cel earest lot line__1-_'3____.. Numberfof lines--- ----------------F __•Length of each linel9p-3 1.,- dA of trench___. "�1�n-_____-_._-__ ,Type..of'fiter material__13_0 -r----Depth of filter mate�ial_._� _`� oto ength__________`z__0��____` --------•-- # -" Seepage Pit: i Distance;to nearest well______._�_--__-._-- pistance from foundation__________________.Distance.#o nearest lot line----.-___________ .�..� ❑ Numljertotof pits----------------------Lining material-----------------------Size: Diameter-------------- --- ---Oepth--------------------------------- Q Cesspool: Distance 'rorrl�nearest twwell-f Distance from foundation------- R-_:lining material----_________________________________- ❑ Sze. Diameter- ----- ------ Depth ='=', '"' w Liquid Ca Capacity --gals, a '-- �► 'N. -j � # ! ---c- l t„P- tY 9 Privy: Distance from nearest well----- T -_______ _______________.-.--Distance from .nearest building : ,.-, . ❑ Distance to neares# lot line------------ -------------- t ---'-:--:--#---------- #-------E------------- Remodelin9 and/or r6pairing (describe) ' � t - — - i � `--UI` ; ----- --- --=------ --------------------------- ------------------------------------- ------ , ---------------------------------------------- -•----------------------------------------._...----------------------- -------------------------- ---------- ---------------------------=---------------------------------------------------------------------------------------------------------------------- '---------------------- ------ 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. (Signed)---- - ` ----------------'---------------------------------- --------- ------------------------=---------(Owner and/or Contractor) B • "-------••----------•-------------------------------•--- ---------- ------------------------------------ (Title)_ (Plot plan, showing size.of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----,T --------------- ---- =.-DATE I �� ----- REVIEWEDBY------------ ::----------------------------------------------------------------------------------------- ------ DATE BUILDING PERMIT ISSUED_-=------------------------------------------- __= - --=- DATE. == - Alterations and/or recommendations:______________________ - •---- -------------------------- ------------------------------- •----- -------------- ---... NF1;_ i. �, •J"f �,.y. w:. ----------------------------------- -•------- --------------------------------•---------------------- ---------- ----------------------------------------••-----------•---:------------------------------------------- I ------------------------------------------------------ -- - - - --------- --- A � f'{ r FINAL INS E`CT-1 - - ------ Date-------------- = SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California P• ES 9 REVISED 8-59 3M 3-'63 F.P.CD. .rte a ' r