16788 - Laserfiche WebLink

Home Browse Search

-- -V - r. OR OT rHCE USE: j G -----_ °•�--2�. ---- Permit No. . 1 . D- r -d APPLICATION FOINANITATION PERMIT ---------- ---- ---- --- . ,.�m. ------------ ------ _ (Complete Du�Slicate} � Dafie`Issued ___ •- T This Permit Expires 1 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 with County Ordinance yNo. 549. _____ - -- ------------ ------------------------------•----------------•--- J08 ADDRESS AND LOCATION_f ----------------- Owner's Name._ �P�-�,?---- ----------- � --- ----------------------- -- --------------Phone ------ Address----- -----•------------------------------ ----- --;------------------•---•---------------------- -------•----••--------------------------------------- -----------•------------------------------- ------------•------•----•--------••---------- Contractor's Name �� ------ Phone---•---_-•------•--...----------- Installation will serve: Residence N---Apartment House E] Commercial ❑ Trailer Court [IMotel El Other ❑ rf __________________________________________ Number of living units: __/__ Number of bedrooms ?� Number of baths _f_.._ Lot size ____ _._- Water Supply: Public system ❑ Community system ❑ Private 2--6"pth to Water Table_______ ft. Character of soil to a depth of 3 feet: , Sand E] Gravel [I Sandy Loam El Clay Loam ❑ Clay E] Adobe E] Hardpan ❑ Previous Application Made: (if yes,date:�"- _F- No ❑ 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.) i Septic Distance from nearest well-----------------Distance from foundation--------------------Material ___-__._._.______.___-_------------------- ----- ❑ No. of compartments-----=---- -------------- Size----- ---------------. -----Liquid dep.h----------- --- ------•-.-Capacity...----------------- t Disposal Field- Distance from nearest well--_-_Distance from foundation_- .�--- Distance to nearest lot line-- `-----_ =---'Len th of each I., .Width of tr ch._ ---- --- - � Number it lines----------------- ------ g Type of filter material_ t'_ ---Depth of filter material_____ _ --�--.-Total le_ngf�h_- ' ~` �� D tance)o nearest lot line_-____._-___..._ .► Seepage Pit: Distance to nearest well___-lam'-------Distance from foundation____ __ ,__ s� NumberCof pits------- ---------Lining material-- a-�_.Size: Diameter_ _-_. _----...__.Depth_...__ - ------ p4 Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- 0 ___._.___________---_______--_ _ __❑ ♦ Size:• Diameter----- -------------------Depth----------------------------------------------- Liquid Capacity gals. . - Priv .Distanee-from nearest well---------------------___---_____---------------Distance from nearest building_,______ Yq 'fir w,:_;:ce'to n e,,� --------------- ------------------------ ❑� Distance to nearest-lot line_.f_-�------------------------------------------------------------------- � '-� O Remodeling and/or repairing (describe):---------°----- --- -- ----------------------- -------------------------=-----•----------------- ; t �------�...-- _ ---------- -------------------------------------------------------- ------- -- - ---•-------------- ---------- i ` ------------------------------------------------------------------------------- I hereby certify that I have, prepared this application and that the work will be done in accordant with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. �/ /% � --_-*__ q __ ________________.(Owner and/or Contractor ---------- - - ---- ------- - - ---------- ----------- -- -� ----- -m s etc.,scan bt .. " ----- le}---------- -----_- --------------.------ -- ------ ------ --- -- (r (Plot plan, sfiowing size of lot, location of system in relation to wells, bui�ild g_, e placed on reverse side). ►n Y� � t s FOR DEPARTMENT USE ONLY q� APPLICATION ACCEPTED BY______________ ------------------ DATE------� == / ----- !�7---------------- REVIEWED BY---------- ----- --- ----- -- --------------------------------------------- DATE--------------i----`----------•-------------------•------- BUILDING PERMIT ISSUED-------------------------------------- ------ ------------- DA;E = �� Alteratiorks and/pr recommendations:----- - ��-- `�p -� ------------ -- Z� lt- ------ ----- - - rb•t $U { --------------- ✓✓ J FINAL INSPECTION BY:--------- --- -- ---- l--`-�----- ------------- Date - �� ry = k SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxetton Ara { 300 West Oak Street ~ i ±` �Tt_4 Sycamore Street 205 West 4th Street Stockton,California Lodi,California Manteca,California Tracy,California J ES 9 REVISED 8-59 3M 3-'63 F.P.CO. r, •�