Laserfiche WebLink
FOR OFFICE USE: <br /> ------------------------------------------------------ <br /> --- -- ------------------- ------------ -------------- <br /> APPLICATION FOfSAI;TATION PERMIT Permit No. ..�r`:a::�- <br /> (Complete-in Duplicate) <br /> This Permit Expires 1 Year From Date Issued Date Issued <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. f1J y,,, <br /> 77 sir "xr.'i------�.._�- -/�-._/,l ----------- <br /> JOB ADDRESS AND OCATI N�?A __ <br /> Name .. -•------..-.. --.-.- Phone------------------------------------ <br /> Owner's <br /> Address-------- ---•--/-----/ le2—Z.:-- ---- ••.. ...... ......... <br /> Contractor's Name......,-Zoom--------------------­------- -• ---- ------ ----- ------------ Phone.----- ............................ <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial E] Trailer emrt 00 Motel 0 Other ❑ <br /> Number of living units: 1. ----- Number of bedrooms -.. Number of baths -E--...- Lot size ---- A-1� JL----- --------------_-----------.-.- � <br /> Water Supply: Public system [I Community system ❑ Private'M Depth to Water Tablel!O- ft i <br /> Character of soil to a depth of 3 feet Sand ❑ Gravel ❑ Sandy Loam (�] Clay Loam ❑ Clay p Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date------------------- ) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank:,, q Distance from nearest well --"-..Y Distance from foundation-.A-a----..----.Material ..C{E✓Lrn ------------------ --------- <br /> `'NNo. of com artments2-.'._'---.--- . Size- '�-t--ppf -%r----Liquid de th- - - Ca acif j --- <br /> Disposal Field: Distance from nearest we[i..J."1r.'4.-.-Distance from foundation-Z-O-------------Distance to nearest lot line-.r ---__-.--- <br /> Number of lines ----A-------------------------Length of each line-- -- lJ' _-.-------...Width of trench-_r�'-y------------------------ <br /> --------Depth of fitter material--4----------------Total lenth----lap---------------------------- <br /> Type of filter materiai��-_Jl'.•..---.- p g <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------.---- Distance to nearest lot line----------------- <br /> F1 Number of pits... ..................Lining material---------.-.---------- Size: Diameter-----------------------Depth--------------------------------- <br /> Cesspool: Distance from nearest well ----------------Distance from foundation................. ..Lining material-----------------------------..----.-. <br /> ❑ Size: Diameter- -- -------------- ----------------Depth--- ------ ---•°--------------- -- ----------- ---.Liquid Capacity- ------------ -------------gals. <br /> Privy: Distance from nearest well ________________________________________------__Distance from nearest building-_____-___----_-_-_--------------------. . <br /> ❑ Distance to nearest lot line --- ------- - ------------------ ------------•------------------------------- ------------------------------------------------------------- <br /> Remodelingand/or repairing (describe):--------- ------------------------- -------------------•--••------------------------------------------------------------•-------------------------------- <br /> ------------------------------------------------------------------------------ --------------------------------------------•------------------------- ---------------- --------------------------------------------------- <br /> -------------- ---- --------------•----------------------------------------------------------•-----------------....--------------------------------------- ----------------------------------------------------- <br /> I her cer ' y that 1 have pippared this�I�Znof <br /> ication and that the work will be done in accordance with San Joaquin County <br /> or roan s, t e s, and rules a d�regulLocal Health District. <br /> (Signed ---------------------- ----------- ----•--•---------- -------------------------------------(Owner and/or Contractor) <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-- - - - -AAWX------------- --------------------------------------- DATE__('-4. <br /> -------------------- ----------------- <br /> R <br /> - -- ------- ----------------- <br /> REVIEWEDBY--------------------------------------- - --------------------------------------------------------------------------- -• DATE-..-.-.- -----------•--•----------- <br /> BUILDING PERMIT ISSUED.------- -- ----------I------------------- -------------------- -- ----------------- ---------------- DATE----------------------- - - <br /> Alterations and/or recommendations-------- --------- -------- ------------------- ---- -------------------------------------------•--•----------------- ----------------------------------------- <br /> f <br /> --------------------------------------------------- -- ------ ---------- ------------ ------------------------------------------------------------------------------------ ----------- ---- --------- -------•---------- <br /> ------------------ ---------------------- -----------------•--.-------- <br /> FINAL INSPECTION BY:f✓-- - ..................... <br /> Date-,.-------- ........ --- ---- ---------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Noxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi California Manteca,California Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press ` <br /> i _ <br />