Laserfiche WebLink
rUKUrHUL USE: <br /> ---------- <br /> --------------------------------- <br /> ----------- <br /> - - - -- --- L <br /> APPLICATIO �f-OR—SAN �4T 3vI�T Permit No. <br /> ..------------------------------------------ -- ------- `--!"._ - (Complete in Duplicate <br /> - -.-_. This Permit Ex ires 1 Year From Date Issued ©ate Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION----- ±------_--SF_{... <br /> `s„__ <br /> Owner's Name-------------------- r € �, .-c � -------------------------------------------- ------------------- ------------- Phone----"= <br /> Address_ ► c Y <br /> ontractors Name = ' -------------------------•----------=---------------•--------------------------------------• •----.._. Phone----------------------------------- <br /> Installation will serve: Residence [ '-Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: J---- Number of bedrooms ___1_ Number of baths -_r-__ Lot size __-____-._ 0'A_____________________________________ <br /> Water Supply: Public system El Community system C] Private ©�epth to Water Table _d_pft. <br /> Character of soil to a depth of 3 feet: Sand Gravel Sand Loam \ <br /> p ❑ ❑ y p'"`Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date--------------------) No [ " '• New Construction: Yes ❑ No*M FHA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: /,� v <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well__-�€ _..a?....Distance from foundation_-._f T_ ----.-.Material------- __°_f-_r_._ <br /> ❑ No. of compartments----------- ----------Size----- ---.b---Liquid depth----------'i---- Capacity-�"a--`---�`------ <br /> .____---__ <br /> Disposal Field: Distance from nearest well._,;__,,Z_Distance Distance from foundation__-_''t. ---------Distance to nearest lot+line____ <br /> Q...- Number of lines---------------` Lengthth of each line_______ -------- Width of trench___,._r_ ----�----------'---�---- <br /> ~ , <br /> Type of filter material---,`��-- - -�--------Depth of filter material---- -_-Total length ----------------------------- <br /> Seepage Pit: Distance to nearest well-----___--------------Distance from foundation--------------------Distance to nearest lot line__.__._________._ <br /> ❑ Number of pits----------------------Lining material---------- ------------Size: Diameter-----------------------Depth............--------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation----_.__-----------.Lining materiaf_l_-------------------------------- <br /> ❑ Size. Diameter--------------------------------------Depth-- -----------••------------------------------------Liquid Caparifiv----,-----------------------gals. <br /> Privy: Distance from nearest well____-----------------------------_---------------Distance from nearest building------------------------------ ------- <br /> F1 <br /> -__._❑ Distance to nearest lot line-------- ----------------------------------------------•-------------- ------ <br /> Remodelingand/or repairing (describe):------- ---------------------------------------------------------------_------------------------------------------------------------------------•---- <br /> -------------------------------•-----------------------------------------------------------------------------------------•--------------------------------------------- ----------------------------------------------------- <br /> ---------------------------------------------------------------------------------------------------------------------••--------•--•-----------------...._.--------------- --------------•------------------------------------- <br /> - -----------------------------------------------------•------------•----- ----•----•------------------•---•---------------°----------•------------------------------------------------------------------------- ------ <br /> I hereby certify that I have prepared this application and that the!work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)----------------------------------- ----------=-------------------------- ------------------------------------------------ --------------- ---------------------(Owner and/or Contractor) <br /> 13 . -- <, :��1,�,6 ---•------------- <br /> Y-it r -_ (Title)------------------------------------------- - -- ---- ----- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY____-'_._ '� _:. . 20 41 <br /> - DATE <br /> REVIEWEDBY------••----------------- ----------------------- ----------------------------------------------------------------..... DATE--------------------- <br /> BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------ <br /> Alterationsand/or recommendations---------- ------------ --------------------------------------•--------•------------------------------_.-.--------- ----------•------------------------------- <br /> •------------------- ------------------------------------------------------------------------------•------------------------------------------------------•----------- <br /> --------------------------------------•-•-------------------------• ------------------------------------------------------------------­----------------------------------------------------------------------------------- <br /> ---------------- <br /> -------------------------------------- --- ---------------/-� --------- -----------------------(�-------------------------------------------------------------------------------------------------------------------------- <br /> F€NAL INSPECTION -- I ----- L. F Date-------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazet on Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> i 9 REVISED 8-59 3M 3-'63 F.P.CO. <br />