18159 - Laserfiche WebLink

Home Browse Search

1-UKUNIC : USE: . i --l'-�- - � --------------- ----- ------ APPLICATION' �R'SA�+f i�- iTAT14N PERMIT Permit No. ............... ----------------------------------------- ---------------- ---W--- -r -- - [Complete in Duplicate} ------ ------------- -------- This Permit Expires 1 Year From Date Issued Date-Issued-7!/ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work This application is made in compliance with County, Ordinance No. 5 herein described. �. JOB ADDRESS AND LOCATION-_--___- _ 3r, - - _W F , . Dom' Owner's Na �' , I�-.T. / f --•�---�.------•---•-----'1--JF-_ 2-'.7_-,Lc.-/e ��-- `� l Address-_. - :._ _t?__ -------------- TPa tply= --------------------------- 6 i Contractor's Nan'e�--------•-� /� C { , -------------------•--------------- _- , I _1 -.1_ ti�-- Z" 'e------------- - ' : y: Phone.']-V4 Q 7 Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court`❑ Motel] Other ❑ Number of living units: ---- Number Number of bedrooms-,k-- Number of baths ---1--_ 6� ` .,t:.. Z .l f , Lot size ---------A- Water Supply: Public system Comm unity.. ste Y y ❑ Private ❑ Depth to Water Table'-.7f ft. I Character of soil to a depth of 3 feet: Sand Ej cGravel-❑ Sandy Loam,T Clay Loam ❑ Clay ❑ Adobe Hardpan Previ l s Application Made: (If yes,date-------------- -- lConstruction: ❑ P ❑ No New Yes�' No ❑ FHA/VA: Yes ❑ o,® TYPE,OF:INSTALLATION AND SPECIFICATIONS:` ` (No-septic ta4"or cesspool permitted ifspublic sewer�is available within 200 feet:) I Septic Tank: Distance friom nearest well-----------------Distance from foundation____ �.. 1 _-,..._,•_,__� � K --fT.Material---_-�/PE--.�t?_ST'F--__----. No. of compartments--_I__--- Size_ �Q_-_ --_Liquid de -------�`r -----Capacity----4? i Disposal Field: Distance from-nearest*wet �. �€DisEarrce from foundation_- /------------fT 'cr Dis�asDistance to nearest lot_ Lenline--- -- Number of lines------------ _ I Egt of each line-.- _ .3D f1--_�/idth of french------ -----7 Type of filter material_---_- �G�/�''_Depth,,of filter material:_,--_If_-- ----- Total length-__------_-- Seepage Pit: Distance to nearest well __-_-_-----_-------Distance fr m foundation----,/ DistanceLinin . �` Ifi to nearest lot line_- --_-.-- ' Number of pits---------,� ' g materia'!__,- /�-Size: Diameter.- Cesspool: Distance from nearest well-----------------Distance from foundafion----------_---------Lining material-------------------_---- ---- i ❑ Size: Diameter------------------------- ------ i--- -----Depth ---- ------------------------ --------- -------------------- Privy!, -- - --Liquid CapacifiY f� - �. - .._. (/v rDistance from nearest well---------------------------------------------- Distance from nearest buildin ' ❑ Distance:to neares}.lot fine--,--- ---#__ Remodeling and/or repairing (describe):---_--1Vtrl/_____S.,4 0 T/G'_---> t►m. sr- 44�)/ 6v-�W-- 1�GG -------------------------------- --------- 1 ------------------------------------------------t - 1 Ct l hereby certify that ! have - z ,------------------------- -------------•------------------------------------ Y Y prepared this applica+ion and that the work will be done in accordance with San Joaquin County ordinances, Stat ws, and rules and regulations of the San Joaquin Local Health District. (Signed)-------- F - By:--------- � caper and/or Contractor) .- _ _ -------------[Title) ----- _ _ (Plot plan., showi g size of lot,,location of system in relatio to wells, buildings, etc., can be placed on reverse side). + FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-.---/ - ----- ----------- DATE---REVIEWED BY ------------------------------ BUILDING I/ --`- - ------ l+ING PERMIT D-------------_---_,---- ---_---- --------------------------- ------------------------••----- - DATE ---------------------- ---- ------- -------------------- -- DATE k_ /-Altert.ons and/or recommendatons:--------/I//- ------------ l -- -- - ---------- ----�--------- --------------- --------- -------------------------------------------------- --------------------------------- -------- Y I FINAL INSPECTION BY:------- - � ------------ - Date. ------ - ---------------- S JOAQUIN LOCAL HEALTH DISTRICT , 1601 E.Hazeltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 4th Street Stockton,California Lodi,California Manteca,California Tracy,California CS 9 REVISED 8-59 3M 3-'63 F-p.CC.