Laserfiche WebLink
FOR OFFICE USE: 3� Fff M I o 7u K ;d <br /> ----------_---!•---------- <br /> --- ----------1 <br /> ----;(_ a,E � $.-----------y -- -_---- APPLICATIONMIT Permit No. .�,2_ ff <br /> -- -------------- ------------- ------------------ -- (Complete in Duplicate) <br /> ------------ This Permit Expires I Year From Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> -______.F_ __ { <br /> JOB ADDRESS AND LOCATION.................. <br /> ----- -------=��-��P�: �_. �----- -------------------------------------•--------------------------------------------------- <br /> Owner's Name f -�l�.f-._ Phone <br /> r -- .r <br /> Address------------------------ ---- .... � � f <br /> Contractor s Name___A_*V__;4V t <br /> Installation will serve: Residence 60-`Xpartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ----1__ Numbet=of'bedrooms - Number of baths __ __ Lot size /_ ____ ______________--.---_.- <br /> Water Supply: Public system ElCommunity system [IPrivate Deptih to Water Tablev-_ft. <br /> Character of soil to a depth of 3 fee+: SaGravel ❑ Sand Loam IQ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: (if yes,date-A_..__......... .) No New Construction: Yes ❑ No akll_�A/VA: Yes 5R--_`No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> P / P s � ---------------------------ration-------------------.Material------ ----------- ------------- ----- <br /> Septic Tank: Distance from newest'well_________________Distance from found <br /> No. of com artments- -- -- ------ -----Size ---Liquid depth__-,-----------------------Capacity----------------------- <br /> I <br /> Disposal Field:. Distance from nearest39 well..................Distance from foundation-----------------_Distance to nearest lot line-----.-._-------- <br /> �S Number of lines--------1-11----------------------Length of each line f----------------------------Width of french------------------------------------ <br /> i <br /> Type of filter materiall}•k---------.___-._._-Depth of filter material_.__.--------------._-Total length-------------------------------_---------- - <br /> Seepage Distance to nearest well`f!--- ____-__Distance�Vm f�ndation__/_!�7_f___._.Dista.-.Distance to nearest lot line �---_ � r <br /> Number of pits._-_ 1 Lining materiaL_IzI.60-VISize: biometer._ _____...___Depth----c�?_ <br /> Cesspool: Distance from nearest well__-____--__-_._-Distance from fWneia+FTS___................Lining <br /> . _. --- material- <br /> -------------.-_.___.___._____..__ <br /> ❑ Size: Diameter--=----------i----------------_.---- De th-------- - ---:-_ ----- ------------------- .Liquid Capacity---------------------------gals.. <br /> Privy: Distance from nearest well..........--------.--------- ______...._.__.. ._Distance from nearest building._-_._---_----------_.-.-__-__-.____._._. <br /> (] Distance to nearest lot line . rr <br /> _-.-ip--�---1-K--,----_-:----�----------- <br /> --------- <br /> ---------- ------ <br /> ---------------------- ----------- <br /> --------------- <br /> Remodeling and/or repairing (describe:____..._.__...__ ��� ----- <br /> --------------------- ----------------------------------------- ---------------------------------------- ------ --------------------------------------- ---------------------------------------- ----------- <br /> ------ ---------------------------------------------------------------------------------------------------•------------------------------------------------------------------------------------------------------------------ <br /> 4---------------------------- <br /> I hereby certify that I have prepared this-applica+ion—and that+h weork will-be doon"eiln accordance with San Joaquin County <br /> ordinances, State I andrules and reaulations of the San Joaquin Local Health District: <br /> (Signed)---------- --t -- -----/--------------------- ------ <br /> ______________ Owner and/or <br /> on rac <br /> By:----------------------- e--A-_ .— - F ------------------------------------(Title) f ? t - 4 <br /> (Plot plan, showing s' a lot, location of syste4rr in relation to well"';b�ldings, etc., can be placed on reverse side). <br /> l; FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ---------------------------------------------------- RATE ? f�6 <br /> REVIEWEDBY-------------------------------- ---------------------------------- ----------------------------------------- ------------ DATE-------- ---------------- ------•----------------------- <br /> BUILDING PERMIT ISSUED---------------------------- <br /> --- ----------- - -- ------- - --------------------- -- DA-TE ---------- ------------ <br /> Alterations and/or recommendations:---------- - ---------•------------------------------------------------ <br /> - -I--------------------------------------------------------------•---­-----------------------------•------•--------------- <br /> -------------r------------------------- ----- ----------------------------------------- -------------------------------------------------------------------------------------------------------------------•--- <br /> -------•-------------------------_1--------------------------------------------- --- ------------------------------ ---------------- ---------------- <br /> ------------------------------------------------ -- - -------- ------------------------ ------- -------------------------- --------------------------------------- - -------.----:------------------------------------ <br /> FINAL INSPECTION BY:.------. ----- x --------:__. Date > <br /> SAN JOAQUIN,LOCAL7HEALT,.H`DISTRICT w <br /> 1601 E.Haxetton Ave. 300 West Oak street t 124 Sycamore Street 205 West 91h Street <br /> k Stockton,California Lodi,California Manteca,California Tracy,California <br /> f <br />