10193 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR N PERMIT Permit No. ....1 Z (Complete in Duplicate) /0/ Date Issued .......... CS I 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 Ordinance No. 549. JOB ADDRESS AND LOCATION--------- -------- -------- Owner's ---•--Owner's Name-------, •--------- --------- ----- -- ---------------------------------_------ ---- ---- Phone -----•--- Address--- �1 �/ •/ ,E?, .E�±c €t�✓� Fz�A Contractor's Name --- ----------- -------------------- Phonea'`�c`3Ze Installation will server Residence Apartment House [ICommercial F] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms __ _-- Number of baths J___ Lot size .........42Z. _x-l-r.I--d.................. Water Supply: Public system Community system E] Private ❑ Depth to Water Table ..�/a_ ft. Character of soil to a depth of 3'feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan gy � ❑ Previous Application Made: Yes ❑ No x New Construction: Yes ❑ No [ FHA/VA: Yes ❑ No, TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) epi Distance from nearest well_.-----------------Distance from foundation__-----------------Material------- ------------ ------------------ ------ No. of compartments----------- ----------Size------------------------, __,.Liquid depth--------------------------Capacity..... -•---.....--- Dispos i Id: Distance from nearest well----A/bll/i�.-Distance from foundation_--,?-V.........Distance to nearest lot line .7 .... Number of lines________ ____ ___ - _. ----Length of each line------. (1 j Width of trench------ V-� -_----...... Type of filter material----•�a�-�--__`Depth of filter material----//__-_--__--Total length-----!Q............................ o � � w Se Distance to nearest well----1JOAX�_---Distance fr m__foo/undation_._1.._._.._.....Distan�e to nearest lot line_��I.......0 Number of pits-------P------------Lining material...___210 21041 _Size: Diameter----- .--_-_--__- Depth-_-- _ ____________ esspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------ ____--- _---. -_-----__-- Size: Diameter-------------------------------------Depth---------------------•------------------------------Liquid Capacity----------__-------------:gals. Privy: Distance from nearest well------------------------------------------------- from nearest.building----------------------........,__._-__._. ❑; Distance to nearest lot line-------- ------- -------------------- ------------------•------- ------------------- --- Remodeling an / repairing (describe):__-__._ ,;��>,. .��.____ �_�.___� ............. '�` ---'�-� ........... ..................................... ----------------------------------- - - - - •--- --------..........-------- ------ ----- ------ ---- - ` --------------------------------------------------------------------------------------------------------------------------------------------------------_------------•--------------------•------------•---------------- 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 regul 'ons of the S aquin Local Health District. ----- --- -•-``-=- -. -------(Owner and/or Contractor) (Signed)----- 4- , ---- (Title) ra-x. (Plot plan, showing size of lot, location of system in relation to wells, ildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- ---• ------ ------- ------- ------ DATE.....------. '� - REVIEWEDBY------------------------------------ -------------- --- --------------------------------------------- DATE----- t�•.................................... BUILDING PERMIT ISSUED......................... --•--- DATE-------------..._-------_----_-------------------------- Alterations and/or recommendations:----------------------------- ...........................................--•------•------------------•-••--------•---•- ---------- ----------------------------------- -= 4------ 47 FINAL INSPECTION BY: '----------------------------- -------- Date------/J - �-`' -- ----- ------------------ -----• SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California ' Manteca, California Tracy, California ES-9-21A , Revised 1.57 F.P.CO.