21708 - Laserfiche WebLink

Home Browse Search

r -------------------- ------ ------------------------ -- -------------------------- -- ------ APPLICATION- OR ANITATION PERMIT Permit No. _ .170 ------- y ' __ (Complete,IIn Duplicafe) This Permit Ex fres i Year From Date Issued --- ------ -- --- ------- ��- - 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 'th County Ordinance No, 549. 'JOB ADDRESS AND LOCATfON _- :I_0UI SE - �� _ :tea- �4_ Owner's Name----- t�'_1 .I~-- ---•----------------------- - -------1__140M_IPSo nl 4 ------------------------ --------- Phone--- - -- = l Address"----•-=------•--•--- -'-�------�f SC_.-----•--_`�C�•L------------M�n1T�C�_, --- ----------•- iContractor's Name------�w�.�]-„__----•---•--- �, ---•---....... Installation will serve: Residence p ' •--- ------- ------ Phone------------------------------- Commercial ----------- ------ " A artment House ❑ Commercial ❑ Trailer Court ❑ Motel Number of living units: Number of bedrooms ❑ Other ❑ -__ Number of baths z-_ Lot size "-"::ISQQQ"- C! r � Water Supply: Public system ❑ Communit s st ,�� Y Y ❑ Private LvJ Llepth to Water Table "Z3.- - ft Character of soil to a depth of 3 feet- Sand Gravel ❑ Sa dy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Ha Previous Application Made: (If yes,dote------ ------------- ❑ Hardpan ❑ ! --- ) No New Construction: Yes ❑ No �HA/VA: Yes ��No TYPE OF INSTALLATION AND SPECIFICATIONS: ;'(No septic tahk`or cess'ool _7ermitfe'd-if puhlic-iewer is`availab[e wwitFii OD`feet�~' �� .�- - Septic Tank: Distance from nearest well------_- -----Distance from foundation.-_--" F_XK5T(W� No. of compartments--------- Material - ----- ------- Disposal -----------Liquid id de th------ -- --- Disposal Field: from nearest well""-_-`�.�-._Distance from foundation".lQ. � - --" ---Capacity-"--------------------- Distance �15T7Mai- Number of lines-.--_----r� Distance to nearest lot line__-5____""-•_ Length of each line"SQ"rf. --.--Width of trench..._"-2- "-. r Type of filter material"-_�Q-�.�"--._Depth of filter material"__.._� -"- rc r = r, -----..Total length ------lQ Seepage Pit: Distance to nearest well -------------Distance from foundation__________________, Distance to nearest lot line_"._______.___..• ❑ Number of pits.-_ --__"-- --- ---Lining material---------------------- Size: Diamete -----------------------Depth ___ -------- .....___ Cesspool; Distance from nearest well ................Distance from foundafiion---._---._-"" --- Lining material"."..--- = El Size: Diameter- -- -- " _-- --_-- -- -----Depth_.-_-___ --- I --- .................. ................ Liquid Capacity--..------------------ PrivY: Distance from nearest ________" . -_-- ------------------------gals. .................Distance from nearest building-.. ----_-------- ❑ Distance to nearest lot line__________ ------ .--".-__- ----------------------------------- ----------- ----- -- - Remodeling and/or repairing (describe):_------ADO-ADOLQl1I{}L�" - ------- - -------- - ----------------------- -------------------------------- --- ------------•-------•-------------------------.------------------------------------------------ .-------------.---ACounty--- I h ' by certify that I have prepared this application and that the work will be done in accordance with Sayordinances, afe ws, and rules d regulat' s of the San Joaquin Local Health District. (Signed)----- -_ 4 I - -- --- --------- ------- ---- ------------------ ------------- BY:-- - } .- - - -- wner a- Or) (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR ------ ------- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY"___. _--t1.1l•.Q-_--_--"-. --__---- � r REVIEWED BY I DATE - �f- - ------------------------------------------------------------- DATE------ BUILDING PERMIT I55UED___ -" -"-.....#"_-_____-._ -------------------------------- DATE -.............. Alterations and/or recommendations:__".# ---------------- -•--•-----------------------•------- I ....... -- --------- ------- FINAL INSPECT BY: - _ Date`.., f ----------- ------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. " 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California F E.K 9 2M 1.67 Vanguard Press Manteca,California Yraty,California