12755 - Laserfiche WebLink

Home Browse Search

_ L'f - APPLICATION FOR &ITATION PERMIT Permit No. ...l.�_..�:�..5 4140 (Complete in Duplicate) 4_ . This Permit Expires 1 Year From Date Issued Date Issued ...... . ....... Application is hereby made to the San Joaquin Local Health District for a per it to construct and install the work herein described. .This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION--------?10 .9Outh A€�h s �1 Owner's Name. fit n4_.02_ _.Q11 -----------•------------------------------------------------------------- Phone H©' 4...9. --- Address....................21.05...'`i--"----Ash•. 31A 1 ------------ Contractor's Name-------- �1 A r�® t1C...Tahk ►S__ery C L T21C' - Phone -H©' • ''1.26.`.. Installation will serve: Residence [X Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ /11 Number of living units: __1_-- Number of bedroo Number of baths --- ... Lot size -------- O..X---15 - -............................. Water Supply: Public system [X Community system ❑ Private ❑ Depth to Water Table _45_ ft. Character of soil to a depth of 3feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe X] Hardpan ❑ Previous Application Made: Yes ❑ No ® New Construction: Yes EX No ❑ FHA/VA: Yes ❑ No []t 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_._.--------------------Material- ----- E;Aating No. of compartments--------------------------Size--------------------------------Liquid depth----------------------- Capacity Disposal Field: Distance from nearest well__----------------Distance from foundation....................Distance to nearest lot;line.................. EXIgting Number of lines-----------------------------------Length of each line------------------------------width of trench---------- Type of filter material._.-. _.-__-. Depth of filter materia-----------------------Total length._.___ Seepage Pit: Distance to nearest well n0 308t \ _. _.. ._...__Distance from foundation................!!_.Dispance to nearest to�line._.5�__..__.._ 0 [ Numbe 'pf iks , ,..�.._...___-Lining material_.._rV.Ck.__..--Size: Diameter___.33..-__....__.Depth__z�+----maX•---_-___ Cesspool: Distance from nearest well............._._Distance from foundation------------------..Lining material----------- -------------- ❑ Size: Diarherter..---- .t------------------------- ----Depth------ •--------•--- ---------Liquid Capacity.... ...............gals. Privy: Distance from nearest well_______________________________________ ----------Distance from nearest building_____________________ ❑ Distance to nearest lot line Remodeling and/or repairing (describe):------ dding---Fit-t_enn-Ba.d...t_O-_.exiating---ald em................"..__....:. ________________________________________________________________________________________________•____.-_.-_•._-.-___.-.-_.__-____-.____. A' _____________________________:.._.._-___-.------------------------- -------------------------- ___----------------___________________---------------------------------__----------------------------------------------- _________________________________________________________________________________ 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 regulations of the San Joaquin Local Health District. (Signed)--------------------11-el1a---Sej3tilo---T=X---�ei_'_Vlcea----jI1C.... (Owner and/or Contractor) By: Ferry 0.a---Worthen-------- . Title Gene---.M re ----- ---- - -- -- -- - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT,USE ONLY APPLICATION ACCEPTED BY------------------------ DATE REVIEWED BY- --------- ---- 9-- A-- ---------------------------------------- _. .DATE ------ BUILDING PERMIT ISSUED -•---• ------------- -------•----------. DATE----- ----------------------- ' ------------------- ----------- Alterations and/or recommendations:_------------------- - ,,,�.: l -------------------------------------- - -- ---..z--r =�:--------------- 0th 0,3------3 �.�•--- - ----— - ------ ° - 1 --------•-•••. ` - - 2-�5 6 = Q - ---- ----------------------------------------------------------------------------------------------------------------------------- ---------------- --------- 62- FIN INSPECTION BY: Date 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-9-2M Revised 8-'59 F.P.Co. ..