15925 - Laserfiche WebLink

Home Browse Search

FORPOFl E USE: jr/, c3�, yY 63-- --------��_3� --- _----- ---.- ..._-..--- Face APPLICATION RX 'NITATION PERMIT Permit No. . S� --------------------------------------------- (Complefe in Duplicate) Date issued --------------------------------------------------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the Sen Joaquin Local Health District for a permit to construct and install tie work herein described. This application is made in compliance with County Ordinance No. 549. Gtr-��'` /f-�-P� P..��t� ? As.s -QAekj 3.6_30 , JOB ADDRESS AND LOCATI --- Owner's Name----------- � � lahone.- f 1 '`.. '�`-1- Address-----------------.......................... --------------------*----------------------------------------- Contractor's -------------- ---•-•--------------------------------------- Contractor's Name - '`'F---- 1' -�' r cx_ti..--�'' r-------------- Phone.. Installation will serve: Residence 1Z Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___?_ Number of bedrooms___ Number of baths __1-.. Lot size .......1-y_-...+'... s -________________ Water Supply: Public system ❑ Community system ❑ Private ®' Depth TO Water Table - eft. i Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Q' Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date____________________) No R New Construction: Yes [y No ❑ FHA/VA: Yes ❑ No [j2-� i TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ` i - t -- - F Septic Tank: Distance'from,.nearest well— _Distance from foundation_____l �__..._.Material..._'_ __ p No. of compa"irtmofrs— -------2�----Size •___, Liquidcdepth__......`�' --------Capacity_. Disposal,Field: Distance from near�t°'well__ a`_ istance from foundation__ _'?--: F'Distance to nearest lot line________—(-- Number of lines______ '___-__�--- ___._--___Length�,of each line--------- _-G.S"Width of trench_____________ Type of filter material____ .r--ras�Depth of filter materiai______,l_ __��_.Total length_______________ _�'__ �___�-^'�Q' ,I Seepage`Pit: Distancelto nearest well------ _-_Distance from foundation__--/__,&_ ._.Distance to nearest lot line...... (� Rr" Number of�pits�_._�_� -------Lin ing material_ _.Size. Diameter----3_z3_�--------Depth__...._----__�`_--_--------- Cesspool:� Distance from nearest well-----------------Dista ce from foundation------------.-------Lining material--_.__._______________________....... Size: Diameter---------------------------------------Deth----.----------------------------------------------Liquid Capacity gals. �! Privy: Distance from nearestwell------_------______________-----_ -_----___-----Distance from nearest building------------------------------------------ I ❑ Distance to nearest lot ine-----------• ----------•_�.----------------- ................___•--•----------------••-----••-•-----•----------------------------------- Remodeling and/or repairing (describe);;_`_:= = 1 n --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------•--•-----•---------------•-•---------------------4_S!------------- I hereby certify that 1 have prepared this applicatft9 and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the. San Joaquin Local Health District. Si ned ( g )----------- --- --------------r-- / (Owner and/or Contractor) p I ------------------------------------------------------------------------ ------ „ (Plot plan, showing size of lot, Iota+ion of:system in relation to wells, build ings,iet�., can be placed on reverse side). 1 � w i 3 R DEP ENT USE ONLY APPLICATION ACCEPTED BY---------- _F_________ "" I rz_..P DATE REVIEWED BY------------------------• -- ----- •--�----� ------------- BUILDING PERMIT ISSUED------------- ) --•---------- -- DATE----------------------------------------- a and/or recomme dations:_$_^_i _` ___.__i��___I%- f23�_ lC __ _ � i ------------------ �. 5 C-t� --------------------------------------------- -- ---------------------------------------------------............. FINAL INSPECTION BY:---C�, .............-------------- Date---.�_'_.l-3.z.__1., ----------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,Catifornia Manteca,California Tracy,California ES 9 REVISED a-59 2M 5-62 ATLAS !