Laserfiche WebLink
FCR OFFICE USE: <br /> --------------- <br /> -0 FOR8ANITA- TION PERMIT ______ <br /> 97 <br /> --- ------- APPOCA W' Permit No. <br /> .......... -------- ----------------------- <br /> R il I A, <br /> ------ --- --- (Complete in Duplicate) -31YIAII 5- <br /> ---------------------------------- Date Issued <br /> ---------- ------------ This Permit Expires,l Year"OFrom Date Issued T------------ <br /> Application is hereby made to th6-San Joaquin Local Health DiOrict for a permit to construct and install the work here-in described. <br /> This application is made in compliance wi unt nange No._549 lq htb <br /> JOB ADDRESS AND LOCATION------ ----------- V-7e----------------------------------------------------------------------------- <br /> Owner's Name---- ---------- ........ ------ . Phone------------------------------------ <br /> Address--------1,20-------0ay-------- <br /> ----------- <br /> ----------------------------- --------------------------------------------------------------------------------•---------------- <br /> G ---------------- <br /> ------------------ -- ---------- <br /> Contractor's Name------- k _.S_ j,_- ---------------- ----------------------------------------------- Phone__YA_�f, <br /> Installation will serve: Residence E3 Apartment House 0 Commercial [] Trailer Court E] Motel 0 Other E] <br /> Number of living units: 1---- Number of bedrooms .f.---- Number of baths __2----- Lot size ---- 0 <br /> -------------------------------------- <br /> Water Supply: Public system W Community system [DJ- Private F1 Depth to Water Table -AP- ft. <br /> Character of soil to a: -depth of 3 feet: Sand E] Gravel [] Sandy Loam EJ Clay Loam El Clay El Adobe R3"Hardpan F1 <br /> Previous Application Made: (if yes,date--------1�------------) No E] New Construction: Yes U No [e— FHA/VA: Yes F' No El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No Septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well__A&?x_-r__Distance from foundafion-.IP------------ <br /> No. of c omparfments------;4-z--------------Size-X!�-r"K--?-k--.f—/--Lil,-id depth-----Y CapautY �`' r <br /> Disposal <br /> lepth-----Disposal Field- Distance from nearest weII__/Kf�,&_-_-r__Distance from foundation--------------------Distance to nearest lot line---.---.----_---. <br /> Er <br /> ine----------------- <br /> Er Number-of-lines-: -------------:---------Length of each line__ff59?..1'_2_"u--------Width of trench_�`------------------- <br /> Typ6 of filter materia __.....Depth of filter material--------F '---------Total —----------- <br /> Seepage Pit: Distance to nearest well-------------'.-.---_-Distance from foundation-----------_-------.Distance to nearest lot line------ ---------- <br /> 171 Numb_er---t4_pits--- ------------------Lining material-----------------------Size: Diameter------------- -- -----Depilr—-— ----------------------- <br /> Cesspool: --Distance from nearert-weI1--------------------Distance from foundation--------------- ing materia#------------------------------------- <br /> ❑ Liquid Capacity_.------------------------gals. <br /> Size. Mamefer----­ ------------------ Dept�,_____ ---------------- <br /> Privy- Distance from nearest well------------------------------- <br /> Disfance from nearest bu�Vng---------------------------------- ...... <br /> Fl Distance to nearest lot line._-----. <br /> --------- -- <br /> ----------------------------------------------------­-----------db <br /> Remodeling and/or repairing (describe -----------------------------------­------------------------------------------------------------I--------------------- -------------------------------- <br /> �51b�, jb� <br /> --------------------------------------------------------- —----------------------------------------------------------------------------------------------- ------------------- -------------I- <br /> -- <br /> -------------- <br /> ----------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------- ----------------- --------- ---- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------- <br /> I 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 +he San Joaquin Local Health District. <br /> (Signed)--------------- --- ------------------------------------- --------------------_ --------(Owner and/or Contractor) <br /> $Y:----------- ---------------------------------------------------------------------------------- -------{Title)------------- -------------- ------- ......... ...... <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.... -- -—----------------- ------------------- DATE-------JA.Zll?� ------- ------------ <br /> REVIEWEDBY---------------------------------------------------------------------------- ------------------------------------------ DATE------------------------- - -: <br /> BUILDING <br /> ATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE-------------------------------- ------------ --------------- <br /> Alterations and/or recommendations:------------­1------------rl ------­ ­- - ------------------------------------------------------------------------------ ---------------- ---------- ----- <br /> ------------------------------------------------------------------------------------------------------------ -------------------------------- ---------------------- --------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•------ --------------------------------------- <br /> --- --------- --------- - ----------------- - ---------- --------------------------- ---------- --------­_­------------------------------ -------------------------------------------------------------------------- <br /> -----------------------------­­------------------------------- ----------------------------------- ------------------------------------------- -------- --------- ---------- - ------- -------- - -- ----------- -------- <br /> ------ -- - --- <br /> } <br /> - - ---FINAL INSPECTION B ----------- ---- ---- I-------------------- tT,,te--- ­7 ------ -- ----- -- <br /> Y:'. <br /> ------ ----- <br /> SAN rJOAQUIN LOCAL HEALTH DISTRICT <br /> 1 <br /> 1601 E.Hazellon Ave. 300 W st Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lo 1,California Manteca,California Tracy,California <br />