19743 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR .rANI'PATION PERMIT Permit No.114, ...�.. � -- ------- ------ -- ------------------------- (Complete in Duplicate) Date Issued --------------------------------------------.--------.---- This Permit Expires I 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. 5_499. JOB ADDRESS AND LOCATION------------------------------------ 1'ti` ._.._./4_ s--_ ,--- --------------- Owner's Name-------------- > ---------- aUfdl? — ----------------------------------------- ---- ------ Phone-_-------------------------------- Address-------------------------------------------------Z"_ o_ _ ---SY---r----- --------------------------.......-----------------"•-•----r--------� Contractor's Name_ £ _ __- ltq.� ----off __-[ t------ Phone_ �lz^- Q 7'Y Installation will serve: Residence G&�artment House ❑ Commercial ❑ railer Court ❑ M tel ❑ Other ❑ I-- - Number of living units: __.1____ Number of bedrooms Number of baths : __ Lot size ___._____- - :�.__ ------------------------------- --------- _ Z-"- .__..._ Water Supply: Publics stem Community system Private p pp y: y ❑ y y u�i�De th to`Water T.a`ble ___ __ t. 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 ConstrTVion: Yes ❑ No 6P--rH_A/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Seplic-TonkDis arace�from„r:earest well=__.—.__—_._Distance.from foundation--------------------Material_________________________________..________- Ed��+' .• Noof compartments------ -----.��-11-----------Size------------------- ------------Liquid depth.------------- ---------Capacity----------- i Dis sal F d: �] Ditance from nearest wail-ICY- ! Distance from foundation-__._/ _.___Distance to nearest lot line__._ _____ �/ Number of lines_________ ___ _______ Le gt{i of each line `-_`--_�`_--.Width of trench_. '+ "-------i_______._ y' -•fh of filter material-----I- ----_--..Total length--------------- Q-f---------- T pe of filter materia Dep S a e Pit: Distance to nearest well_: _ __ _____ _Mi�ta'nc�iom founclation.,_/V_r_.___.Distance to nearest lot line__.______ W r __--..Size: Diameter.-.-- 1p Nm4�er of pits----- --------- -"---Lining material-_= " -_.___-Depth---.r�ra ______.------------.� Cesspool: Distance^from nearest well-----------------Distance from foundation___._...__ .___.___.Lining material__.___________.____.______--______a_- ❑ Size: Diaameter--------------------------------------Depth------- -----.--------------- Liquid—Capacity-------------------------i--gals. y Privy: Distance from nearest well-------______________�____-______'_'-_-----------Distance fro nearest building__;--.--------.______________--�..____�. ❑ Distance to nearest lot line-------------�,.J_l ----------------------------------------- ---: -------------------------------- - -i------ f Remodelin and/or re Ginn descrii�e __._._ - ____--- ` f 9 / p g ):------ ----------- �-a/ : v --•--•------•------------------•-------------=--------------- --------------------- - �?!� _ F r`1/...f? � ------=----------- !i N -! a' /__j [- -------------------------------------------------------------•-----------------•-----------•-------------------------------------------------------------------------------------------------------------`------.__•r_1' 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 San Joaquin cal Health DistIict, f ) (Si9ned T \ f� -------------------------------------- w �oritractor] By:-------------------------------------------------------------------- ------ ---------------- --- - (Title)----------------------------------- (Plot plan, showing size of lot, location of systcmin rela ion to we , buildings, a c., can be placed on reverse side). , FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ __ ...__ �. -----------�---------------- ------------=-------------------------- DATE=--�.f`-.=�='-�-`�=------------------`-_:---------- REVIEWED BY-----------)------ ---------------- ----- -- --------------------DATE_------- ---------------------- ---- - !.✓I ------------------------------------------------------------ -- -------------------- BUILDING PERMIT ISSUED — - DATE----------------- -'---------- ----------------- E or 5. ' -------------- f -------------- Alterations and/or recommendations:_tl.�' ---s=------`��'----- ------- '-��-=� " ,..-- -----------------------------------i--- ----- ------------------------------------------------------------ --------- ------------------------------------------------------ ------------------------------------------------------------------------------- I I ----------------------------------------- --------------------------------------------------------------- ----------- ------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:- �f------------------ ---------------- Date-- ------------------------------------- -------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1641 E.Hazelton Ave. 300 West Oak Street 124 Sycamore street 205 West 9Th Street Stockton,California Lodi, California Manteca,California Tracy,California F.P.CC.