18652 - Laserfiche WebLink

Home Browse Search

FOR'OFFICE USE: f; --------------- --------------------------------------- - APPLICATION FOR SkNITATION PERMIT Permit No. -_/_. ........... ------------------- :------------- ------------------ (Complete in Duplicate) / -- -------- This Permit Expires 1 Year From Date Issued 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 com Bance with County Ordinance No. 54.9. ",LdB-- O`D" Z-F MrG1q _ JOB ADDRESS AND LOC -1u�-ATI - A- -_. n II-Sc'----OF------A STI_P4--------Rh---------------------- Owner's Name------------- {�0 ---•- { -�►�. r!' L- _� Phone Address----------- - `-_ X'------z �---------- T -------- ------------------------ l-. � � . Contractor's Name---------------- 1�/ _I�- -------------------------------------------------------------------------------------------------- Phone----••---- •-------•----------- Installation will serve: Residence �partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: j-___'Number of bedrooms 3--- Number of baths -*Z'- Lot size __1��__- -----�-5��7._t-------- Water Supply: Public system ❑ Community system ❑ Private [moi epth to Water Table ft. Character of soil to a depth of 3 feet: Sand [e Tavel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (if yes,date ----------._-__---1 No 4New Construction: Yes 12�o ❑ FHA/VA: Yes ❑ No [a - TYPE OF-INSTALLATION.AND_SPECIFICATIONS; _ (No.septic tank or cesspool permitted if public sewer is available within 200 feet.) p (� Septic T k: Distance from neatest weli____4�.___Distance from foundation-_10-------.Material-----HjE wao�_:-_.._. No. of compartments------ ---.-. «_X_�__Liquid depth___ ___�-----Capad#y..l?_ _Q-_ Size Disposal Field: Distance from nearest well:_-��.Q__..-Distance from foundation--ft ______ tante to nearest lot lirie_� _----. Number of lines-------- _...._.. }--.Length of each line--✓`d- - ----._.-Width of trench-__.3 ;._-- .----.---_lit 1 Type of filter mate Depth of filter material----.11- _-..--.-- Total length---- _~'____ - Seepage Pit: Distance to nearest well------------------=---Distance from foundation-----------------.-.Distance to nearest lot line__-_--.:-__----:R, Y [] Number of pits-_------------------Lining material----------------------.Size: Diameter--------- ----De th--------------------------------- I. � p , Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material-----------.----------------------.--. ❑ Size: Diameter fr ::"--.Depth <-------- __—=�, -= —Liquid.Capacity----------------------------gals.,1 t ___--_ .'--------------------------- _ --Distance from nearest building___-_----..---_:__ -------------- ----. Privy: Distance from nearest well- I # ❑ Distance to nearest lot line-----------r---- --- ----------.f-------t------------------------------------------ ------- -------------------------------------------- Remodeling and/or re airing 1 ------------ --------------------- ±---l--=------- ---A--,-Y----------------- - -"------------•-------- ----------------------------------------a- `y'� � � ~ .. ° ------------------------------------------------------------ 1% � E ._ ----------------- --------------------------------------------------------------------'----------------- ----------------------i 1 ---------------------------------------------------------------------- F ! 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 rules and"regulations"of:the'Sat# Joaquin.Local Health District. /��.�j .� f /fes• . (Signed) Y� �ry t ----------------Y---:- - - _.(Owner and/or Contractor) ----------------------------- ----------------- -------- -------- ` --- ------Title----------- --- ---- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR-DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- R _ - ------------------------------------------------ DATE------ X17. - ...... REVIEWEDBY---------------- -.. ----------------- DATE------------------------ BUILDING PERMIT ISSUED-----------------------------'.;-.---------------------------------------------•----- '-- --------------------•----------------------------- - - --------- DATE------------------------------------------------------------ Alterations and/or recommendations:-------------------------------------- -- -------------------------------------------------------------------------------------- ------------------ -- ------------ ----------------------------- --- INSPECT = '��`� Date ---------- FINAL �-----�----------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazetton Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy, Californiafi