14969 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: w J 9 ---------------------- ------------------ APPLICATION FOR 5ANtTAT10N PERMIT Permit No. ...l.••-•Y" ----- " (Complete in Duplicate) /t ------------ ---------------------- Date issued --------•�-.:.----- ""--" ----------- ------------- This r This Permit Expires 1 Year From Date Issued ....... - --- n is hereby made to the San Joaquin Local Health District a permit to consfi�uct and in the work herein describe . Applicatio Y This application is maade.in�coo compliance.with County Ordinance N �.! f., ,� - = . - Y-----•------•---•---- JOB ADDIt1rSS AND LOCATION._. - Phone______________________ ! ---•---- --- --- ---- - ----•-••-•---••--._ Owners.Name. --• -------•--- i• -If- rr R� e 4� � ' a Address-- Phone. �� - ' -----------•----------------•--•--------•-- - Motel Other ❑ Contractor's :-------•• ,._ Trailer Court ❑ ❑ 2 ' Apartment House ❑ Commercial ❑ Installation will serve: . Residence ® I P l / ,5 _ _ .----•• --__ Number of baths r u Lot size __. Number of living units: _1T.__ Number of bedrooms -2__ i' Private Depth to Water Table 7�-•• ft• "��'�-`AAdobe Hardpan ❑ Water Supply: Public system ❑ Community system ❑ IL Clay Loam ® Clay ❑ ❑ Character of soil�to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Y FHA/VA:Yes ❑ No ❑ Previous Application Made: (if yes,date.-- -- y No New Construction. Yes ® No ❑ TYPE OF lN5TALLAT16N AND SPECIFICATIONS: (No._septic_tan( o icesspool.permittedTif;public sewo0tts�+vailabie within 200:feet•) •- -` w � O'�_ __Drstance'from foundation ---.Material_.-.---• - �, P' '� 'r S` Liquid depth_-------q---------- ----Capacity. . Sceptic Tank: Distance from nearest well_ . - _ q No. of compartments-" P----!--` S`ze. - ,-pistance to nearest I t lines (�aa'3 i ..Width of trench.-J& d�"•� •--••-•- Disposal Field: Distance from near3}y elL ��--____Dength offancreach line�om founclatio -� � . Number of linesf ---.Total length__ a•-��¢ ' " ----Depth of filter material_.__/. .'---•-- 1 Type of filter mater aI I.- J stanc to nearest lot line��---•--- Distance to nearest;wet_-- -�-=-- Distance from foundation--/4r-------- , A. ' Number of pits----1-------------Lining material - Size: Diameter --• DepthI - ---Depthi --------------------------------- 0 _._.from f -ion----------------••-Liquid Capacity.-! gals. Distance from nearest well_________________Distance from foundation__.____._____..___..Lining matperia .-' -= -'-.--- Cesspool: # ❑ Size: Diameter -------•------. " Distance from nearest well_________________________________________________Distance from nearest building.______.___.__.__.__.._.._ - Privy: ------------- ---•-- ❑ Distance to nearest lot line-------------------------------------------•----•----- --- i .-----• ---•---------------------•------- Remodeling and/ repairing (describe)---------------- ------__--•---------••----••- -- -----"•------------•--- -•--------- r1 -------•------------------------------•--•-----•------••---•----------------------•------------------- -------- --- --- that I have prepared this application and that the work will be done in accordance with San Joaquin County I hereby certify ordinances, State . and r le d�regullatiionf the San Joaquin Local Health District. i ---------------------------------------------------(Owner ner end/or Contractor) l' (sign .- [Title) �"' laced on reverse Side)- By: z . -- -- ""- " buildings, etc., can be p T�°�'r(Plot plan,showing slxe of lot, location of system m relation to"we s, ( FOR DEPARTMENT USE ONLY ------------- -- -------------------•-------•------------ ---------------------------- ------------------- APPLICATION ACCEPTED BY-- - - - -- - - - ------------------•------ - DATE-_.__..--__.----------------------------------------- ----- REViEWEDBy BY--------•----------------- DA ••------•------•----------- BUILDING PERMIT ISSUED-------- - --••-------------------- ------------•----- _._- - Alterations and/or recommendations 1_7 --"---••--._._ ------ --------------------------------------- •.. ••-----•------- - _...---•- _ -------- - ----------- � � - .x/ :. -63 -------------- F ate---- - ------ ------ - - FINAL INSPECTION B ---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 124 Sycamore Strad 205 West 91h SIM41 300 West Oak Street Tracy,California Stocklon,California 130 South American Street 1 Lodi,California Manteca,California EB 9 REV4SE7 8-59 2M 5-61 ATLAS