Laserfiche WebLink
.-- = <br /> APPLICATION <br /> ( mplet in Duplca,s� at <br /> \ t the work herein described. <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and s <br /> This application is made in compliance with Co ty Ordinanc o. 549. <br /> g 1 1 � Y_ _4# <br /> JOB ADDRESS AND ATION --- ---.---- =-- -- -. ff�--`--- <br /> Owner's Name---- .-:_.. <br /> Phone -,_ �P -------- cc,' <br /> -------------•---------•------------------- y <br /> Address-----------------•---/ r.�f�-.> r.�'--- -�i��!.------••---------•-------------- - <br /> �__r � -------------;� Phone <br /> Contractor`s Name---------------------- - -----•------ ---- - <br /> Installation will serve: Residence [ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> �® Q-' �- <br /> Number of living units: I------ Number of bedrooms _y Number of baths _ -_____ Lot size ------- ---------- <br /> ____ ____ _ <br /> Water Supply: Public system ❑ Community system ❑ Private J9 Depth to Water Table'qQ-- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ . Gravel ❑ Sandy Loam ❑ Clay Loam [I Clay ❑ Adobe ] Hardpan ❑ <br /> Previous Application Made: Yes ❑ No New Construction: Yes No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ` , <br /> -�_ .. <br /> i Septic Tank: Distance from nearest well__�Q.______-Distance from fo}indation_:,� (�� i ��� � i <br /> No. of compactmems..--- .-----------Size_�'� e}_ _ fQ__ '� •Liquid depth-----=-- ---------------Capacity ------------ --- , <br /> • �--------Distance to nearest lot line_E----:____ <br /> Disposal Field: Distance from Weare twell..__/...It�__.._Distance from foundation_�� <br /> Number of lines-------------------- ------------Length of each line---_' _f1-- ----„_-------Width of trench_-- ___-- --`------------------- <br /> kitOCr Total length '' --------------------- <br /> Type or filter matenal-�_�.____-_.___C__Depth of filter material-____�.�_ --_ <br /> Seepage Pit: Distance to nearest well ____________--------Distance from foundation--------------------Distance to nearest lot line_------------ <br /> i ❑ Number of pits-- ------------- ---Lining material-----------------------Size: Diameter-----------------------Depth------------------------------ <br /> Cesspool: Distance from nearest well--- _______-Distance from foundation----------__--------Lining material-------------------------__------- <br /> Size: Diameter----------------------------- <br /> _ <br /> ❑ ---------Depth----------------------------------------------------Liquid Capacity---- -----------------gals. <br /> Privy: Distance from nearest well-------------------------_-----------------------Distance from nearest building-----.---------------------------------­ <br /> Distance to nearest lot line------------------------------------------------ <br /> Remodeling and/or repairing [describe]:____ ___ <br /> --------- <br /> ----Z---:-:t--I-- <br /> ---------•------------------------••------------------•---------- <br /> _ ' ��i _'tom l "aP' <br /> ----------------•--------------------------------•-•------------------------------- <br /> - --------------- ----------------------------------- ------------------------------------------------ -- -----------------•-------------••------------ ---------------------------------------------- <br /> 1 hereby certify th-t hhave repared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances,.S a <br /> aw <br /> s,., ndrruW and r.=-e. uTationsYof the.S'a�n-Joaquin,L`oc' <br /> al,Health,Distract.� <br /> r . (Owner and- o-r tContractor) <br /> ------- . ---- <br /> (Signed) <br /> T ------ -------------------------- <br /> - <br /> ' <br /> By:------------------------- <br /> (Plot plan, showing size of 4r.,location of system in reiXon to w�ls,buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY DATE---------- '� --------------- <br /> --------- �` <br /> REVIEWEDBY----------------------------------------------------------------------------- ---------------------------------------- <br /> BU1LDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------ ---------------------------------•---- <br /> Alterations and/or recommendations------------------------------- ------------------------------------------------------------ --- <br /> i ---------------------------------------------- <br /> ------------ ----------------------------- <br /> FINAL INSPECTION BY---------------- -/----- --- <br /> /� <br /> y ..- --�-�-._�--•---- Date--- ---- ---------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 300 West Oak Street 132 Sycamore Street 814 North "C” Street <br /> !30 South American Street TracCalifornia <br /> C <br /> Stockton, California Lodi, California Manteca, California y. <br /> ES. 9-2M 10-52 Revised W-2100 <br />