Laserfiche WebLink
FOR OFFICE USE: <br />_______________________`F__..__..._..__.. <br /> APPLICATION F611'SAWTATION PERMIT Permit No. <br /> -------------------------------I..... ------.---- <br />------------•--------------------------------- ----- -- (Complefe",in Duplicate) Date Issued <br /> ----------------------------------------------------- This Permit Expires I Year From Date Issued - ------------- <br /> Application is hereby made to the San Joaquin Local Health District for a.permif 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 d r S <br /> -- ---- ------- <br /> -- ----------------------------- - ------ -----_------------------ ----------------1�--- I <br /> Owner's Name----` <br /> ame----M_ '410---1511uz W_Q_&_#f�---D ---- ---—--- - ---------- ---- ----- ----71h.n..__,0---- -- <br /> -- ---------------7------------------ ­-­- ------------------------------------I-----------:------------------ ------------------------------------------- <br /> Address--------- <br /> Contractor's Name----- <br /> -------------- ----------------- ------------- ------- ----------------------------------------------- Phone------------------------------------ <br /> Installation will Residence [A�_�I�arfrppnf_ld_o.use '�Commercial E] Trailer Court Motel Oth <br /> -. . 1'\ <br /> A f.-1-1 00 <br /> Number of living ung s: �4umber of baths ----- Lot size ----- -- --------------------- <br /> Wafer Supply: Public system El Community system [j Private_ ep_t_hto lWate—,_fWblie-$4,rift <br /> Character of soil to a depth of 3 feet- Sand E] Gravel E] Sandy Loam J&�C;ay Loam C3 Clay El Adobe 0 Hardpan 0 <br /> Previous Application Made: (if yes,date................... I No New Construction: Yes [j No.U40" HA/VA- Yes E] . No.0— <br /> TYPE6F INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer-is available within 200 feet.) <br /> Septic Tank: Distance from. nearest well... Distance from foundation---- --------Material ------- ________-_ <br /> V�" compartments__._----------- Siz-4--—----_.-A----- -----------Liquid depth____----- - ---- *.......Ca pacity- I" <br /> — — I <br /> Disposal Field: Distance from neareteIL6_6 Distance from foundation Distance to nearest lot <br /> I �_��Wiclfh of french.--- ------41 - <br /> Number of lines ------- 1-649th of each line.- _50-_ ; �4 -.-Zrf---------- tJ <br /> - <br /> Type of filter materials ". -Depth of filter maferial',ol-0.If/------ -Total lengfh----,5.- --------------- <br /> Distancj,�f I founcLation--737�----.Distance,ig nearest lot lin e------- <br /> Seepage Pit: Distance to nearest weII7-020- <br /> Number of pits--_ ____.I.__.____...Lining maferial--VA- . ---404kike: Diameter__'V_j(_,?-------Depth_ ---_s..______.._ <br /> Cesspool: <br /> --------- <br /> Cesspool: _,'Distance from nearest well ----------------Distance from foundation_._________..___ - Lining material---------Ir---------------­--------- <br /> El. t �,, ` ti Size: Dia-rnefer- -- --------- ----- ----- ----------Depth_.___---------------- ............. ---- --------Liquid Capacity- --------------------------gals. <br /> Privy: 'Distance from nearest wO...----------------------- ------- . ........-Disfance from nearest building----------------------------- ------- -- <br /> ElDistance to nearest lot line ...................:,:'.............. -------------------------------------------------------- ----------------------------------------- <br /> Remodeling and/or repairing (describe):__________--_____. ----- ------------------------- <br /> ---A44,14 -- ----- --- <br /> ---------------I---------------------------------------------- <br /> ---------- --- <br /> ----------------------------------------------------------------------------------------------------1---------------------------------I------------------------------------------------- <br /> ------------------------------------------------------------------------1---------------------------------------------------------- -------------------------------------------------------------------------------------- <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 /> - -(O / C )(Signe8l.... . Y,--- - --- .......— - c <br /> By:------------------------------ - ------ - --------------------------------------- ---------------------------------------(Title)---------- ------ <br /> -------- -------- ---- - - - --------------- <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.__."rip.�.o------------------------------------------------------------------------ DATE_--- 3----- <br /> REVIEWEDBY. ------------------°-- ------------------------------------------ ------------------------------- ­____ DATE------------------------------- <br /> BUILDING PERMIT ISSUED-------- ----- -'-------------------------- ---------- = --------------- ------------------------0 DATE--------------------------------------------- ------------ -- <br /> Alterations and/or recommendations: ---- -------------- ------------------- ---------------- ----------------- ------------------------ ---------- ---- ---- -------- - ----- <br /> ................... <br /> ---------- -- ---- ----------------------------------------------------------------------- <br /> --------- ----------------------- ---------- -- ------ <br /> ------------ - --- ------- ---------- -------- - - ------------ ------------ .. .. ... <br /> ------------- ------- --------- ..........----- -- . ... -------- - ----- - ---- ----- - - -- - ----------- --------------- -------------------------- <br /> _Tre��+ �11 ir 3— 5�- 4�-- ---- --- -- ---------- <br /> FINAL INSPEC Dase---------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycomor;-Street 205 West 9th Street <br /> Slocklon,California Lodi, California Manteca,California Tracy,California <br /> E.H.9 2M 1.67 Vanguarq,Press <br />