17052 - Laserfiche WebLink

Home Browse Search

l F R OFFICE USE: > / i 4. 1 .. ----------- ---------------------- --------- - CATI N APPLI Q � FOR' , X IQN M Permit No. 2— r -- -- ---- Complete in Duplicate',r This Permit Ex ices. 1 Year Fromba Date issued : AF-r: Application'is hereby made to the San Joaquin Local Health District for a permit•to construct and install the work In crt we This application is made in compliance with County Ordinance No. 19.. JOB ADDRESS- ANDk / LOCATION-- --�, --.--_ _ -------------- ------------- --------- -------------- ------------'T = Owner's Name t� --------------- Pho . -= -•------------- ' ne _'` - �� l b Address-------- ----J--l! ------------------------- 'Contractor's Name______ & '_.-/P Rly ----------------•-------------------------------------------------------------------- -_ Phone.-, '` �.....-.. _ �;-- f 's Installation will.,serve: Residence g}l"Apartmen ❑t House Commercial E] Trailer Court ED Motel ❑► Other E] x ti Numbe of living units. __ ._ Number of bedrooms /Z__ Number o baths size s�"PJs!_ff '- ---___'_ ------------ , Water .Supply: Public system E] Community system ❑ Private- Depth to Water Table ft. > ' Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ ,Clay ❑ Aobe' Hardpan r!,c '` Previous Application Made: Ilf yes,date_-_________--------1 No Ai New Construction: Yes �o E] FHA/VA: Yes No �J TYPE OF INSTALLATION AND SPECIFICATIONS: - 1* _ (No septic tank or cesspool permitted if public sewer is available within-200 feet.) s Septic�Tank: Distance from nearest well_________Distant from foundation_ _ �_ _ _ ._ _ _ < ._. ---- - 1�- - - -.Matep�al---�_-----1 �' G+�'_r.�-------- � 'No. of tom artments___ �`'� compartments-_—Z ---------Size�7p__X�Ga�;----=---Liquid depth---- � CapacitY---�i��:___�:�: , Dispo Field: Distance from nearest well.- ------Distance from foundation'__/.V-------- --___.Pistance to nniW t line _ o & Number of lines- ---- - d Y ��' ------ - - `_Length of each line__ �rajr_ Wi th of trentil tx - ItPs L,+ Type of filter materia __ ri >, 4 Depth of filter ma+erial___,� __._--,--Total length___- --_--•-- -��__ 's _ --- {+ Seeps Pit: Distance to nearest waif____ -________ .___Distance €rom foundation_____________,.___.Dis#once to neares# lot line ____ �:'�__': Number of pits--------------------:Lining material_______________ ..Size: Diameter._ -_.______ ----Depth --------------------'�------ Cesspool: Distance from nearest'well__-__-_____..__Distance%om foundation-------------------- - Lining material . , . . . . ❑ .qtr- 5rze: D,ameter---- ?------_----Depth - Liquid Capacity :' *";gals. Priv �� is y: _ �]' tante from nearest well________________________.-,__-_______._,___._._Distance from neares+'building------------------------------------ - ❑ Distance to nearest lot line---------------------------- ------------------------- ------;._r:. ------ - -------° ----- Rehaodeling�arid/or• repairing (describe)______________ -----_- �# ---------- -r --- -- - ' ... - 7;--- -------------- ------------------------ - --- - --------=-----------=--=----------- - - ----- -------------------------------------------------------- s eo - :%;"� 4 : � - ------------. r---'-----'---------------------_._------- p---------:--------------••------------------------------------ -----------------•�=-r`-:-----v I hereby certify that I have prepared this-application and,that the'work-will be done in accordance with San Joaquin.County` -" K ordinances, State laws,.and rules and regulations of the San Joaquin Local Health District. [SignetJl --- ------- ---------------------•------- ----- - r Contractor) -- ' ( P By: --"-------------- �------ rile -. = Plot lan, showing size of to}, location of syst kn relation to wells,-buildings, etc., can be placed on reverse side). A + FOR DEPARTMENT USE ONLY - /4 APPLICATION ACCEPTED BY /1<f. DATE F - REVIEWED BY ------ ---------------------------- - --- -- DATE------- BUILDING PERMIT-ISSUED---------------------------- ----------------------------------------------------------------------- DATE----- Alterations and/or recommendations:____ ---------- --------,-------- / 1 -' � `�-- f- . _ _-� fs�-�-rte}-- -- ----------------------------------------- -- FINAL INSPECTION BY:--./-L/` Date- = ------ '. SAN JOAQUIN LOCAL HEALTH DISTRICT 1641 E.Hazelton Ave. fir' 380 West Oak Street - 124 Sycamore Street 205 West 9th Street rnia Lodi, k Stockton,CalifoCalifornia Manteca, are r ��' � Tracy,California 9:5 9 REv45ED 8.59'3M �3 i.F.ro. „f `�4. '