19294 - Laserfiche WebLink

Home Browse Search

�5 _4UK rrict u5k : . -- - - JLI d, � ----------------z... .-_-- APPLICATION FOR S . -. Permit No. ..... ---------- -------- {Complete In Duplicate) --.--- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOBADDRESS ANDLOCATIO ---------ZY-I -36----------- ��--`------------------------------------=------------------------------------------------------------- Owner's Name------------- - -�`�- _7_.._---- � le---------------- --- ------------------------------- ------- -- Phone------------------------------------ Address..................... _3_.67—_. ---------------------------------------------------------•-------------------------------------------•--•-------•---------------- Contractor's Name-- - -•--•--- ------------------•-----•----------------------------------------------------------------=-----------------._. Phone------------ ---------------------- Installation will serve: Residence partment House ❑ Commercial ❑ Trailer -Court ❑ Motel ❑ Other ❑ Number of living units: ___ _ Number of baths --/---- Lot size ----./-76-:_X_1� ------------------------- _-,� Number of bedrooms ---_ .- � Water Supply: Public systern ❑ Community system ❑ Private epth to Water Table+ a: ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ lay [-] Adobe ardpan ❑ Previous Application Made: (If yes,date---- --- ----------) No 2----New Construction: Yes No A/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well---- O---_--Distance from foundatio -.'-L[1-p.--.-.Material-_-.-_�N------��-- � p� No. of compartments---------�-----------.Size----` ...X�_ ,rY_�__Liquid de th____.,��•------------Ca acit --.- ---___-� Disposal 1d, Distance from nearest we4_,!!2)_-.__.Distance from foundation--_.,/ _�_-.-.Distance to nearest lot line------------- W I [+ / Number of lines__--__._---3--------------------Length of each line--�/49VZZ1_�,5.Width of trench---._�_i------------.___--.___ Type of filter materials-&?A----------Depth of filter material....19.............Total length--------i O------------------_------- t: Seepage P- Distance to nearest well____,///-O_---------Distance from f undation_-__-/,OX---_- Distpn ce to nearest lot line_---t?'r: Number of 'Pits----- .............Lining material__S_4c. -----_Size: Diameter-----dXG___...__-Depth 1.;9.__-.___._.-_-____ " Cesspool: Distance from nearest well------------------Distance from foundation--------- -------Lining material----------------.-----------------.._. ro ❑ Size: Diameter--------------------- ----------------Depth----------------- ------Liquid Capacity------------------- ------gals.. Privy: Distance from nearest well---------------------------------------------- --Distance from nearest Building_--___ _-..__.._________--.----.--_---._. ❑ Distance to nearest lot line------------- ------------------- ----------- --•------------------------------------------------- ----------------------------------------- Remodeling and/or repairing (describe:________________ ----------------------•---•---.----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------1 ----------'---------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- -- -- --- -------------------------------------------------•-------------------------------• ------------------------------------------------------------------------- ------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count+ ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)-------z ---------- - - ---- -------------------------------------------------------- -------.(Owner and/or Contractor By: �/ (Title)_ (Plot plan, showing size of lot, location of system in relation to wells, buildings; etc., can be placed on reverse side). f FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- --�------- ------------ ---------------------------------------------------- DATE-------�4� REVIEWEDBY---------------------------------------- -------- --------------------------------------------------- ------- --------- DATE. BUILDING PERMIT ISSUED------------- - ------ -------------- DATE------------------------------- ----------------------------- Alterations and or r commendations:_...._. _ --------- --------=-- -• ----- / _____________________________ - f -- -lam --��--��=---------�..�,��C-------- -��-------------------------------------------------------------------- ---• ----------- -- ------- ------ ------ FINAL INSPECTION BY:- -- - -jl------------------------- -------- - Date -------------- - ----------------SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California •` ' + Manteca,California Tracy,California