21517 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: IIII = --------------- Permit No. ----------------------- ----------------------------- -- APPLICATION POCSANITATION PERMIT (Complete in Duplicate)------------------------------- Date Issued "{ This Permit Ex ices 1 Year From Date Issued - ----------- -------------- ------- ------------- q :i Application is hereby made to the San Joaquin Local Heallh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinll�nce N,6. 549. JOB ADDRESS AND LO� TION 2-- '4- �� ----- +�f � �/� 0 Owner's Name----______.I__O_/u-- .-. ----• / -- T- T� - PhoneG � ` !_ / Address----------------------- - �j / ?1-- _�i_ ----------------------------------•---------------•---•--------•----4&0_7Z-1... Contractor's Name-- J 1T�::�`.��- - -----•---- PhonelP ll�A,7.. V. �� Installation will serve: ResidenceApartment House E[] Commercial ❑ Trailer Court E] Motel [3Other El r _._ Number of living units: -1------ Number of bedrooms �' ._. Number of baths _-��..__ Lot size -----_---- --- -•------------ - ----- --------- --- Water Supply: Public system [3 Community system ❑, Private X Depth to Water Table b0- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay E] Adobe Hardpan ❑ Previous Application Made: (If yes,date----_.---.._-.._-.f No New Construction: Yes E] No FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if.public sewer is available within 200 feet.) 11! Septic��T++a�`nk: Distance from,nearest well--------------- Distance from foundation--------------.----Materia4------------------------------------..----------- ❑T�l,,t /.tgNo. of compartments----------------- -- Size-------------------------------Liquid depth-------------------------Capacity-----------•---- ------ 1 ---- ° �. Distance from foundation__ --.Distance to nearest lot line__ l9.__.____If `` Disposal Field: Distance from nearest wedbo._.. _ -!� - Number of lines_-- ---- LMZo ength of each line-- --- u--------.�Nidth of trench_._7� --------____________ Type of filter material_ t"f----Depth of filter material__- _ ______.r-Total length----- See pa a Pit: Distance to nearest well-_`0, ---------Distance from f dation__�4`_0---_-Distance to nearest lot line. _------ Number of pits-_ �__.Lining material__-_/�, Size: Diameter . _._.-__Deptn__ __--------------- il: Cesspool: Distance from.-- well-----------------Distance from foundation--------------------Lining material--------.._.--.---_-._-.-_---__.--- Sie: Diameter-- ---- -----------------------------Depth- .---------t=----------------------------------_--:-.Liquid Capacity----------------------------gals. ❑ �• If T Privy: Distance fromi nearest well------------------!-----------------------------Distance from nearest building.__.-.-----__._--------_-__-------_----. ❑ Distance to nearest lot line ---------------•---------------------- -- --------------------- ------------------... ---- µ til r Remodeling and/or repairing (describe):__-- - ----------- IM! ------------------------ --------- ----------------------------------------------------------------- --------------------------------------------------------------- -------------------------------- --------•----------•--------------------------------•-------------------------------------•------ !� ----------------------------------- ------------------------------------------------------------------- I hereby certify that I ha `repared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and ules nd regulatons o he an Joaquin Loc eal+h District: :' �-- _ ....Owner and/or Contractor) (Signed)---- -- -- ------- - - - --- -�-- - -- ------ •= - - - `-----------------------. - - - ��C E-_-- --- l`----- - .1---5�- --- ---- (Title)--------i .- .. ------ ------- ---- . (Plot plan, showing size o ot, location of system in relation to ells, buildings, etc., can be place on reverse side). FOR DEPARTMENT USE ONLY ------ DATE------------- ��fes-------------------- APPLICATION ACCEPTED BY_---_ _ �'�`�' � �` REVIEWED BY-------------------------------- ----------------------------------- ----------------- DATE------.------------------ -------------- BUILDINGPERMIT ISSUED-------------------------------------------------EM--------------------- ------------------- ------- DATE--------------------------- --------------------------------- Alterations and/or recommendations:------------------------------- IIM ---------------------------- ----------------------------------------------•---------------••--•-•---------- !i J l --------------------- •----------------------------------- - --------------------------------- -------------------- ------------------------: — ---- -------------- ----------- --------------------•----------- -------•--- . - --- ----------------------------------------------- A 11 - Date. ' / FINAL INSPECTION BY:---------------- -- = �- - SAN JOAQU`IN LOCAL HEALTH DISTRICT s 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street d Stocklon,California Lodi, California Manteca,California Tracy,California F.P.CO.