22116 - Laserfiche WebLink

Home Browse Search

x FOR OFFICE USE: rr - ------ APPLICATION F4RANIFA7iON PERMIT Permit No. __ _ 1f C -11 A- ..c� 1�..� 5_: �rt Com tete in Qu licate ._.r=- - Date Issued • `' •' v. -__ 'his Permit Expires 1,Year From-Date Issued ��Applicatio�i% )lerebyrmade to the San Joaquin'Local Health District for a permit to construct and install the work herein described. This pplication is"made in compliance with County Ordinance No. 549. ac a "� a 3 JOB• kulbRESSxANDO =ATZN---1I----- 1 4 '- 431hoCn, , •-- --------------------------------- I -------- ---- Phone_.._.. Owner's Name. `' --- Address__.._.. ' - ! I ---- C�{ ----------- 12 ..l.ConTracto.r s Namef ---• -------- --------------------------------------------------- - --------------------- Pone._._.... .. •------------------- : I6s4llatiori will ae; . rye: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ �3 1 .-A 4•nr f I:.,inry unhc• NumiePr of hedrooms _.._ Number of baths ,_- ---Lot ---- '_��-___/ -__SCJ_:=_'_-:_________:_::____ Water Supply: Public system [ Community sysfem ❑ Private ❑ Depth to Water Table _ ---- ft. I C-ka!'acter;of,,"soil to,4_dep#ko#3 dee#'- Sa'nd [I Gravel ❑ Sandy Loam-E] Clay Guam c�.r © Previous Application Made: (If yes,date-.---------.___.__.I No (� , New Construction: Yes � No E] FHA/VA: Yes El No EJ' t +TYi'&OFfINSTALLATION AND-SPECIFICATIONS: -` '(No septicxtank.or cesspool permitted if public sewer is available within 200 feet.)' 5eticTank ! F NI }0---------Material-��-� Z-------'V1'�------------ p � Distance from nearest well____ .__�.___.__Distance from foundation__.___ _ _ No. of compartments-------dam-'---------- --Size---------------•------------=---Liquid depth------------- - --- --- D; -. Capacity...��a �A�"- `- I i .!9 , I Dis osal Field: 'Distance from nearest welL.Nrl�..__.._Distance from foundation.____I��•�--r-Distance to nearest lot line_____________ ...�....,. / t f � I Number of lines---------- ----------------------Length of each line--- _.-_____-__--.Width of trench------a_�----------------_-._-- F Type of filter material__SV.900S....Depth of filter material_.--- S/--------I Total length------��.�_-----.___ Seepage Pit: Distance to nearest well------------------A_Disfance from foundation____!------------- Distance to nearest lot line----------------- Num.ber _-___-__---.-- Number of pits-------------------------------------Lining material-------------------- - Size:.Dia --meter---------------- ------Depfh- ----------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-__.____.._.__.______----._----______. ❑ Size:,Diameter---- -- ------------------------------Depth------- - ------------------------- ------- --------Liquid Capacity.--------------------------gals. Privy: Distance from nearest well--------------------------------------------.....Distance from nearest bu#Iding__i---------------------------.___.-----. ❑ Distance to nearest lot line ------------------- --------------------------------------- ------------------- -------------- -----------•------------- - Remodeling and/or repairing (describe):----------------------------- ------------------------------------------------------------ --------------- --------------•----------------------- ------------ ---=---------------------------------------------------------------------------------------------------------- ---------------------- ------------------ ----------------- r :. --------------------------?--------------------------------------------------------------------------------------------------------------------------------------------------- -------- - 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. i (Signed)---- - } (Owner and/or Contractor) I y• - Title-------- ._....- ----------------- ------------- B :------•--- -�---------------- (Title) (Plot plan', showing size of lot location of system in relation to wells, buildings,ietc., can be placed on reverse side). i . FOR DEPARTMENT USE ONLY j F APPLICATION ACCEPTED BY____._ - - --- -----�---------------------------------------- DATE- -�-�--� ----.�.-- ----- ------------ _ - ---------------- DATE-------------------- ------- - -------- BUILDING PERMIT ISSUED ----`------------- DATE erations and/or_recommendations 1. -- �k? 1 ---- �`}�T�'E!� �k�v'4�1 �� '-�----- ......JpN--'-• --------------- ...1140-------i 44� �G �-: -Q---- . L 1_ fa. a ----I1LL----S1�1.�.tAva'-w-fa-----�0k1----------- -t ------ low------- t p�r�l----------------------------------- - -------------------- ----------------------- - --------------------- ---- - -------------------------------- -- ----- ------------------------------------- --- ------ - "F FINAL INSPECTION BY:. --- _ r ------------ Date_ � _-_.. _�. SAN JOAQUIN LOCAL°HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,Californias{ y Lodi,California Manteca,California Tracyr California F.P.co.