17150 - Laserfiche WebLink

Home Browse Search

FO�yOFFICE USE: APPLICATION FOkANITATION PERMIT Permit No. ._.(..11_._ __D -- ------- -- --------------------------- (Complefe In�Quplicate) j I Date Issued ----------------- ------------------ This Permit Expires 1 Year From Date Issued 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 made in compliance with County Ordinance No. 54 �,�r �VE JOB ADDRESS AND LOCATIO ._�_ P- -V1,0- -----�r---------------------------------cY_e, �jl ----------- Owner's Name - �f ----------- �� E /cl---- - --- - -------------------------- --- Phone-- Address ' rhd ��`-P-If JUK --------- --------- -- q / B / Contractor's Name_�_.-__�_________'__�-_�-____ - . ,---- --- ---�..__ �_�-�__._�1. '--- Phone,-4( __-�,x Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ .� Number of living units: Nu er of bedrooms --'V- Number of baths I`." Lot size --------.- Water Supply: Public system [ECommunity system ❑ Private ❑ Depth to Water Tabled ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date--------------__...) No ❑ New Construction: Yes ❑ No W_--FHA/VA:—Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ; (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I S c TDistance from nearest well-----------------Distance from foundation-------------------Material------------------------------------------------- LA No, of compartments �®_-----r-- ----Size--------------------------------Liquid depfh-------------------------Capacity----------- ------- saf N: �J Distance from nearest well—._.Distance from foundation------ 0___.-_.Distance to nearest I t ling___ ---_ Number of lines__--_-I-_ _.-_ .-.- ---Length of each line_- _ -____-__ Width of trench..... T e of filter materia rT yp IVLFU Depth of filter material length---------------- �________ See a e Pit: Distance to neareyt well__j_p-01-0-------Distance from foundation---1_01 -- ---------Dis}Wce to nearest to line------��-- ---��----De th--- ,� .. Number of pits--- ______.________Lining materlal_ QG -----Size: Diameter_ p �________________ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- O- ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----•----------------------gals. i Privy: Distance from nearest weft---------------------------------- ------------Distance from nearest building_______-_-_-----_---__-_--_--_____-_-_-_-. ❑ Distance to nearest-lot line---------------------------------------------------------------------------------------------------------------------------------------------- 77 Remodeling and/or repairing (describe): --------------------------------------------------------------- Y ---------------------------------------------------------------------- �Jlj vry::----I - -.If-_F I -, , - ---------------------------------------------- 40 N 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, nd rules and regulations of the San Joaquin Local �lth District. - � l (Signed) kx_, - - 1._.! -_ ------- ---------------------------------( ;�6or Contractor) 1 By:---------- -------------------------------------------------- �- -------------(Title)------- -------------------------------------------------------- C t --------------------------------- --------- --- - - - ----- -- -- (Plot plan, showing size of lot, location of system in rel Ion to wells, building , et ., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----A ------------ --- -- ---------------------------------------- DATE —` ------------=--------- REVIEWED BY---------------------------------------------------- ------------------•----------------------- DATE----------------------- ---- ------------------------------- BUILDING PERMIT ISSUED------------------------------ ---------- ------------------------------ DATE------------------------ -------------------------------- Alterations and/or recommendations:_-___-�_`___ _ _______________�___-_ ----------------------- ��=_=_z:�=-�____f. _____ -•---------- --------- ------------------- -- ------------------------------------------------------------•-------------------------------------------------------------------------- ----------------------------------------- -------------------------------------------------------------------------'-•----------------------------------------------- ----•---------------- --------------------------- ---------------------__------------------------------ -----------------------------------------------•----•---------------------------•------•------------------------------------------------------------------------------------------------ ----•----------------------- -------------------------------- ----------------•-•----------- ------ - -- ------------ -- FINAL INSPECTION BY:. --------- Date------ -�/�----- -- ------------------ - ------ I SN JOAQUIN LOCAL HEALTH DISTRICT I 1601 E.Haselton Ave. 3 0 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-'63 r-P.CC.