16405 - Laserfiche WebLink

Home Browse Search

OFFICE USE: ------------------ �_ a 7� - �� - & �� ' / 6 S-_ ___.._______________ -__ ___ APPLICATI4 NITATIQN PERMIT Permit No. ;(..__..._..._. (Complete in Duplicate) "7 f h This Permit Ex ires 1 Year From Date Issued Date Issued /__-Z __ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is mads in compliance with County Ordinance No. 549. JOB ADDRESS I AND O AT . . _. --- y_��0-------------------------------- Owner's Name_---- = ?hone------------ -.. • � i --------•------- Address------------------ --•---Address------------------ ------ ----- 2r� 1 . Contractor's Name--- --------------•- —---------------------------------------------------------- --------------.. Phone----------------------------------- Installation will serve: Residence `Apartment House' [] Commercial L] Trailer Court ❑ Motel ❑' Other E] Number of living units:. __:___ _ Number of baths _ __ Lot size ` Number of bedrooms --� � .. �--��-✓��1'--=--------------•--------- --•-- Water Supply: Publicfsystem ❑ Community system ❑ Private Depth to Water Table __44?4. Character of soil to a depth of 3 feet: Sand ❑ Gravel [❑ Sandy-Loam ❑ Clay Loam ❑ Clay (] Adobe 9j--Hard ❑ + a PP I y �New Construction: Yes *-'Ko ❑ FHA/VA: Yes �'No ❑ ' Previous Application Made: If es,date____________________ No TYPE OF INSTALLATION AND SPECIFICATIONS: r t (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest w __ -� Distance fr�otm./foundation__4109---------Mr.6740-! No. of comartmens-- ______- ...:__ qdepth_ 00 Disposal Field: Distance from nearest well__ --------Distance from foundation-_I®.____- Distance to nearest lot line__.------ ' top Number of lines____{--.. ____ Length of each line__--df--____________-Width of trenchAr__. - IS /i W, ------------ ----fir _ --- Type of filter material_ -_. _, +-_Depth of filter material---/P____-----_-Total length-----�P�_____________________ Seepage Pit: Distance to nearesfi well__IJF0_.._____-Distance from f undation____�s Y_.__..bis nce to nearest lot line--.641- Diameter--J_: _____._- r Linin material_ ��---Size: Diameter_- - ..-------- URI" Number of pits ` g f� Depth_.. ' Cesspool: Distance from nearest well________________Distance from foundation-------------------- Lining material----------------------------------__. !� ❑ Size: Diameter-------------------------------------Depth--------- ----------------------------- ------------.Liquid Capacity----------------------------gals. .t. Privy: Distance from nearest well ______ _____________________._______Distance from nearest building:___:____-______________-_-____._____.__ ! ❑ Distance to nearest lot line__________-- d ---- ------ ------- Remodeling and/or repairing (describe):____----- _ _p11-_ ----•--------------•------------------------------- ------------•----------------------------------------------------:----.-------------------------------------•-------------=-- -------- --------------------- =---------_........----..................... - ---------------------------------------------------------------I------------------------------ --•--=----------------------------------.-,------------------------------------------------------------------------- I• - ----------------------------------------------••----... ----------•------------------•----------------•----------------------------------------- --------------------------------------------------------------------- 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 r es and regulation of the San Joaquin Local Health District. (Signed)-------------------- - ------ --- --- - -- ----------------------------------------- r Contractor) By------------------------------------------------ ---------------------- - --------- (Title) l 1o��------------- ---=--------- (Plot plan,,showing size of lot, location of system i r ation to wells, buildings, etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- •.€Cl �crct_------------------- ---------------------------------------- DATE------- a?-�-�„� ---------- REVIEWEDBY--------------- ----- F------ ----------------------------------------- -------------------------------------- DATE---------------------- , BUILDINGPERMIT ISSUED---------------------------- %--------------------- `--------------------------------,-----------. DATE----------------------- -------- Alterations and/or recommendation __.._ ...i; ---�------ '�'` � �_� - _ -_-_ .•� =�� e�-7 ----------- �� l - � '---------------------------------------------------------------------------- -----------•--------------------------------------------•---------=--- --------------------------------------------------------------- --------- ------------------------------------------------------------------------ ------------------------•-------•------------------------------- ------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------- FINAL INSPECTION BY:--_- 1 ..I -•---------------- Date--------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Noxellon Ave. 300 West Oak Street 124 Sycamore Street_ 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 .3M 3-'453 F.P.DD.