20515 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ------------------ ---- - -- --------------------------- APPLICATION FOR-SA irATION PERMIT Permit No. ... U - ------ -- -------------------------------------------- -- (Complete in Duplicate) � - Date Issued ----------------------------------..___ ___ y '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 wit County Ordinance No. 549. OS3 - 0(40 -n JOB ADDRESS AND OCATION-- _41v— tI ��/` ------... N ------- .moi.•- --� �f✓` Owner's Name--- ------------------------------------ 911!111131" � Phone Address = t f` ' '' -- -- -- - - - - ---------------------------------------- -- --- Contractor's Name---- �''- .L._.. ....,� eo_ay--�"-"----C ff ' `rsz------------ Yho a r1 f . Installation will serve: Residence Apartment House ❑ Commercial [_1 Trailer Court ❑ otel ❑ Other ❑ Number of living units: 4---- Number of bedrooms --_1--Number of baths,,-/--- Lo+,size _"P—-__________________________ Water Supply: Public system ❑ Community system ❑ PrivateK- Depth to Wafter Table -------- ft. Character of soil to.a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam Q Clay Loam Clay ❑ Adobe❑ Hardpan ❑ T PreApplication.Made: .(If_yes,c1ate,-,,__ _- __.._--) No _.N ew,Construction: Yes.❑\. o FHA/VA: Yes E] No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permiffed.if public------- from foundation---- _d__. ._Mate�al r!'_C i/ l 't C ` No. of compartments----------,r'----------Size___13t �[__.. .-_:___Liquid depth----4_"..-_---------Capacity----- _�__�. Disposal Field: Distance from nearest well._-_ _-._Distance from f undation.. Q_____7_..Distance to nearest lot line f�.___ ---- Number of lines---------------�------_------Length of each line----------_--- ____.Width of trench........�--------------______ Type of filter material-__ -----T. " Depth of filter material____ ._-.Total length--------IG`"o-__ -----____"____"_-- See a e Pit: Distance to neares+ well Dist ante from foundation--t" ------Distance to nearest lot line-�_---___._ Number of pits--�`�--; g ----- ------- p ;1j -- ____Linin material-- t Size: Diameter- '$/ __-De to ____"_._._."_ Cesspool: Distance from nearest well-----------------Distance from foundation---.-------- _-_Lining materiafi_______-_----------.-__---..--_--____. ❑ Size:•Diameter------------------------------------Depth-------------- --------------------------------------Liquid Capacity----------------------------gals. from, erswell__._---___________________"-----._.-_-_____._.-_Distance from nearest building.__-_.-.____._._____-_________ Privy: distance aet n . _ ------------------------------------- ❑ Distance'to neare_st lot line-------------------------f R da I' g and/ r repairing (descri e): �" -`----�5 = -�--------10.1 V ---------- ------__"".� W --e-----------\ _----------------------------------------------------------------------- __.__-`f_____r________________________"_"_%______________---_.------------------------------------------------------------------------------------------------------- s 1 I ________________________________"_________----_- _________--.-___-__-_______________"_______-__-________-"_____________-_-___---_---______-__-_.____________-__________-_--.__-.__-_-_.-_____.____.-.---_ .I.here6y certify that I`have prepared_this application and that the work will be done in accordance with San Joaquin Coun+y ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. == Si ned --��___�"-. -- ---- ----------Aj---- --- 0"`_ _----=-=-------- 9 -and/or Contractor]- --------------------------------------- -----------------{Title ./- i"�t'1 N__i� (Plot plan, showing size of lot, Ioc of system in relation to wells, buildings, etc., can be placed on reverse side). 3 FOR DEPARTMENT USE ONLY APPLICATION ACCEPT BY_-._---"_ _ ._._ DATE------. l --------------------------- REVIEWEDBY------------------------------- - - ---- ------------- -- --------------------------- -------------------------- DATE----------------------------'----------------------- ` BUILDING PERMIT ISSUED------------------------------------------------------------------------------------ ------------------ DATE - Alterationsand/or recommendations--------------- ------------------------------------------------,-------------------------------------------------------------------------------------------- ----------=-------------- ------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------- ----------- ......r----- - -- --- -- ------------------------------------------------------- -------------------------------------------• -- ---------------------------------------------------------•--•---- y / I FINAL INSPECTION BY -.- a Date____...____.-_ -_____. ----- ---------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ho:eltan Ave, 1 300 West Oak Street 124 Sycamore Street 205 West 91h Street ' Stockton,California ( Lodi,California .R Manteca,California Tracy, California f.P.Co.