15867 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: -_-_-_______ ---------. ��PLICATION FdRIIrATION PERMIT Permit No. ...�,.7... !�..% -------------1— _ (Complete in Duplicate) L -....-..-.-. 1.-Q,- -- f t --- --- This Permit Expires 1 Year From Dat Is ued Date Issued ... .... ......./ Application is hereby made to the San Joaquin Local Health District for ar ruct and install the work herein described. This application is11made in compliance with County Ordinance No. 549. T %�`/----- JOB ADDRESS AND LOCATION.___.___..3� -- ......._ Owner's Name t.-P � s Phone ---- -------------------------------------- Address................. -5 .�.... ` t --------------- ... Contractor's Name---------------- ------.�: v ................... Phone...9.� S'��2 Installation will serve: Residence P Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ..-_->—Number of bedrooms 3`_ Number of baths,...?-� Lot size ... N... -_'k ._...1 d. ............... Water Supply: Public system'K Community system ❑ Mvate ❑ Depth To Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ rSancly Loam Clay Loam 4 Clay ❑ AdobsA Hrdpan ❑ Previous Application Made: (If yes,date----------------__) No [$ New Construction: Yes 0 No ❑ FHA/VA:Yes,.[] Noy TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well----'>-�-..._Distance from foundation--- ......... .Z No. of compartments--------- -_2--._..- ----Siz .�X.,J` _ ._...._._Liquid depth.-......'�j.�--------------Capacity._.x6'.�._:._��!, !/ Disposal Field: Distance from nearest well---�' •.-Dilance rom fou>dation.....f-.9'....`..Distance to nearest lot line...f G'...... Number of lines......_.__.... Length of each linefr.�efS_X CY_. Width of trench.......%. _._....".-._........ Type of filter material-.: Depth of filter material-__.lg .____._.Total length.......7-4 a-'.................. Seepage Pit: Distance to nearest well ,l�'d--------Distance fr f ndation..........& •...Distance to nearest lot line_zl� .'. Number of pits------3._--.-_. .Lining material..._ ---Size: Diameter....J.3__-------Dep, --- .................. Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material..................................... ❑ Size: Diameter--------------------------------------Depth----------------------------------- ------ ------Liquid Capacity gals. e Privy: Distance from nearest well -------------------- ---_-._.........._-------Distance from -nearest building-.._.. ❑ Distance to nearest lot line--------------------------------------------- -----------------------.........................................------------------------- Remodeling ------ •-- •--------Remodeling and/or repairing (describe)------. --•-- ------------- ---• -----------------------•-----------------•--•--•-•---•-----•..-•-• ......................... •---•-•--------•••-•------•------ i --- ------------•------•-•--------•--- ----• ,-.----•----- -- t -- • -- ------------------ O -------------------------------------------------------------------------------------------------------------------------------•---------------------------------------------------------- •---•----------------- 17 -,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 nd regulations of the San Jaaq ' Local Health District. N Si ned --i------------------- --------------- ---- ner and/or Contractor Bye ......-•••----------- ----------------------- (rifle) (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). /ft/ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- /------- `r ------------................................ DATE......T...ZA_�V,�'�---------------- REVIEWEDBY------------------------------------------------------ -- ---------------------------------------------------................ DATE............................................................ BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommenct Vons•----------------------------------------------- --------•---------------------------------------•--•-- 5, : ..0 -�/_- -------------------------------------- a ------ > _ 7"r FINAL INSPECTION BY:.-. --------------- Date---------- .'1 -lv ......................................... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 144 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS - Y