8355 - Laserfiche WebLink

Home Browse Search

APPLICATION FO.._ ANITA710N PERMIT Permit No. 1.3 ----- n/ I (Complete in Duplicate) Date issued ----------- �.-�. Applica{ion 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. JOBADDRESS AND LOCATIO 1 �'9 P81m------------------------------------------------• ----•------- ----------------------------------------------------------- �g, Owner's Name-------- r. and/iy ale GriffIn.r.. = Phone. H°'- 5-9766.. Address �$J - 8-0118 Drive Name p8�.. O._ @P1C TAYIk , !'rVicBs._-�nC•-----------•--------------------------•- Phone HO. x6g ------- Installation will serve: Residence[Q Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ . -_ Number of bedrooms -----Z Number of baths .1... Lot size -------..50.._A__100----------------------------- Water Supply: Public system ® Community system❑ Private'❑ Depth to Water Table _35.. ft. Character of soil to a depth of 3:!feet: Sand ❑ Gravel ❑ Sandy Loam ❑ " Clay Loam ❑ Clay ❑ Adobe EI Hardpan ❑ i Previous Application Made: Yes ❑ No K] 'New Construction: Yes [A No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest wail-- - ----------Distance from foundation--------------------Material--------------------_-_.----._--------..--------. E4�gting No. of compartments-- - ------ -------------Size.-_--------------•------------Liquid depth--------------------------Capacity...-------------------- Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance„to nearest lot line................. E3qeting Number of lines-----------------------------------Length of each line---------- ------------------.Width of french------------------------------- Type of filter material-.......---- -.Depth of filter material-----------------------Total length........-_-_--------__----_--_--___---_.-- Seepage Pit: Distance to nearest well....-rkO-----------Distance from foundation----AP-1R.....Distance to nearest lot line------ --------- [a Number of pits--------1....--------Lining mate ria l-br.,tck_,----Size: Diameter---33"...-........Depth----------.-----25----------- Cesspool: -.-_.-.-Cesspool: x Distance from nearest well.----------_----Distance from foundation------------- - Lining material....-...----------------._----------. \ ❑ Size: Diameter------ -------------------------------Dernth--------------------------------------------------.Liquid Capacity-.--------------------------gals. \� Privy: Distance from nearest well -...-.------------------------------------------Distance from nearest building.--....."-.--.-------------__---___.-.-. \ ❑ Distance to nearest lot line--------- --------=-- -------•--------------- - -------------•-...-------------------------------------------------------------- ----•-------- ” Remodeling and/or repairing (describe):----------------A,ddl.:139-_-0eeP_89e...pjj... g exiating---sepjj_q..•$y$tem .l --------------- ' I hereby certify fhat 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. ' 4F . (Signed)-------- Ba .ZT1C-a---r-------------------- ------------------------- ----------------------•-- ------------------------------------:.--:.---(Owner and/or-Contractor) By%--------------------------- ---------------------------------------------------------(Title)---aen.---_91!-"- -------------- - ----------------- (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 APPLICATIONACCEPTED BY------------- ----- ----------------=---------- ------ ---------------------------------------- DATE----------------------------------------- ----------------- REVIEWED BY--------------------------------------------- - : -- DATE ----------------------------------------------------------- - BUILDING PERMIT ISSUED----------------------- •------- -------- DATE--f---- ------------------------------------------------- Alterationsand/or recommenda`tions----------------- ------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------- --------------------------------------I------I--------- -----------------------•-- ----------------------------------------......................................-------------------- --------------------------------------•-------------------- ----------------------- ---------------------- `----------------------------------------------------•--------------------------------------------------------... ....-•----•---------•-------------------------•--------•-----------•------------------------------------------- ----------------------------------------------------------•------•--------------------------------------- ,.r -----------------------------------------------------------------------------•------- --- ---------------••---•-••------------ -----------------•------------------ -----------------------------------••--••-------------- FINALINSPECTION 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 145446\ATWODO 12-54 1