22338 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ------------- ----- - ------------- -- ---------------- 33 Fs� ----------------- ------------------ -- ------- APPLICATION FOR SA 41TATION PERMIT Permit o. ................. ---------------- --------------------------- ----- - -- (Complete in Duplicate) Date Issued ---4,;7 ____--------------------------------------........-...... 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 No. 549. o � o JOB ADDRESS A LOCATION....--!------------------f---------.......C---- ----...-----•----- -- --- -- ---�---- -- ------Ao_ ---•---------------------------- Owner's Name---- AcrV�------- ............................. ------- -------------------------------- Phone------------------------------------ Address---------_/11-3, -__ _Ala,------- 1g1_ems- �r `' _ --••---------------------------------------------- - Contractor's Name------_ ��c ----�a--L-c-01---•--- �"� �l l-1 t1 ��------- Phone__yG�",'�. ,, Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/__ Number of bedrooms _ _ Number of baths ----/ Lot size ----.___4S_ C#!4 ---------------- Water Supply: Public system ❑ Community system ❑ Private LE Depth to Water Table-5;;� ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0--lHardpan ❑ Previous Application Made: [If�yes,date./_-j,5- -__--} No ❑ New Construction: Yes ❑ No [o`�FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �[] Tank: Distance from nearest well-----------------Distance from foundation--------------------Material ---.-.-_-.-.-----------__--_----.._--..__----- No. of compartments-------------------------Size--------------------------------Liquid depth--------- ---Capacity------------- --------- r � � Disposal ield: Distance from nearest weli_�...-----Distance from foundation-- p2O---_----Distance to nearest lot line___._ Number of-lines---.-- _____.__. Length of each line_-_----� O......... --.Width of trench------------�............... Type of filter material--_. t ?er_k..Depth of filter material----. --.-Total length._----��_-_--__------------------- 11 Seepage Pit: Distance to nearest well_,1i0-_-_--------DistanceArn foundation--_'i�-4-).--._--.Distanc�g to nearest lot line-AV-_ . -_---_-- - rNumber of pits-_ - - -------Lining material- p�f'__-size: Diameter-_- 3 ------Depth------;?_S- -------- ----- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------._----------------------------- ❑ Size: Diameter-------- ------------------ --------Depth--.------------------------------------------------ Liquid Capacity gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----.--.---------_._----------------.-.__. ❑ Distance to nearest lot line----------------------------- ----------------------------------------- -------------------------------------------------------------------- Remodelingand/or repairing (describe)-----------------------------------------------------•---------------------•------------------- ----------------------------------------------- ------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, ate la s,�aju, and r ulations of the n Joaquin Local Health District. (Signed)--- - ------- ------- ----------- -- --.---- -.(Ow and/or Contractor) -- - -- --------- ----- - - ------------- -- -- -- (Ti+le) (Plot plan, showing size of lot, location of system in relation to weffs, buildings, etc., can be plat d on reverse side). FOR DEPARTMENT USE ONLY IF APPLICATION ACCEPTED BY-.- ��?`� - _ DATE__ -__G _ ' ---------------------------------- REVIEWED BY------------------------- - ---------------------------- ----------------------- -_ --------------- --------- DATE------ ----------------------------------------------------- BUILDINGPERMIT ISSUED------------- -------------------------------- -- -----------—------------------------------------- DATE.--------------------------------------- -------------------- Alterationsand/or recommendations--------------- -------------------------------------------------------------------------------•-----------------------_----------_------- ----------------- ------------------------------------------------------- ------------- -- - - ------------------------------------------------------------------------------------------------------------ --- ---------------------------- - --- -------------------------------------------- -------------------- ----------------- --------------- -------- ------------------------------------------ --------...---------------------------------- ��C.� Rate. ' �7 FINAL INSPECTION B :E -__ _-.. a� ------. -- -- SAN JOAQUI LOCAL HEALTH DISTRICT 1841 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California