20468 - Laserfiche WebLink

Home Browse Search

J-UKl-l-K-t Usr.:* r� ___-------- ---------------------------------------_-.s.---.------_- APPLICATION FOR' i`�ffTATl4N PERMIT Permit No. ...a��J .1�'-.€� r - ----------------------- --- - ------------------------ (Complete in Duplicate) ----------------�........_-,.-------------------.--------- This Permit Expires 1 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 with County Ordinance No. 549. % -JOB ADDRESS A D LOCATION-_--- 1 �-----:%l/-_ - -. ------ ------••--------------------------------------- Owner's j Name' -- ----- ------------------------- --------------- ------ Phone_........................-•---•---- Address---------- ----------------- Contractor's Name---- --- - Phone----------------------------------- ------------ •---•-------••---------------------------------------------------•----------------•----- Installation will serve: Residence ®/partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:/------ Number of bedrooms -- Number of baths 4Z—Lot size .---�/'� ------------------------------------ Water Supply: Public system ❑ Community system ❑ Private [g--[Jepfh to Water Table 0ft- Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam E] Clay Loam E] Clay ❑ Adobe [�rdpan ❑ Previous Application Made: (If yes,date............. -.) No New Construction: Yes ❑ No �HA/VA: Yes ❑ No n-- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sepf Tan Distance from nearest well_________________Distance from foundation--------------------Material_--..---------__--------_----------_._---------. n� No. of compartments---- -------- ------------Size---------------------------- Liquid depth--------- --- ------------Capacity-------------- -------- Disp �Fi-- Distance from nearest well_6J 0...---.-Distance from foundation---x�---..-___-Distance to nearest lot line__/?6` _----� Number of lines-----1---------------------------Length of each line------3 Width of trench-. ----------------- Type of filter material--_./_L A.G_L�-.___Depth of filter material____ 1'- -.-.---Total length_.-..,,3_Q_------------------------- Seepage Pit: Distance to nearest well-_/e-6_..__-____-_Distance from foundation___. ' _-_-- Distance to nearest lot line___ ----------- Number of pits-------/-------------Lining material-�6.��----Size: Diameter--___,3_?... --.--_Depth----. - _/-___.--.- N Cesspool: Distance from nearest welL----------------Distance from foundstion.----_-------------.Lining ma#erial-...----------------s_------____-- ' ❑ Size: Diameter--------------------------------------Depth--------------------------------------------------..Liquid Capacity-----------------------�----gals, Priv Distance from nearest well_------------_ --Distance from nearest building ❑ Distance to nearest lot line- ------ -------------------------------------------------------------------------- ------------------------------------------------------ - Remodelingand/or repairing (descr;be)------------------- -------------------------------------------------•-------•-------------------------------------•---------------------- --------•---- -------------------------------------'------------------------------------------------------'--•-----------------------------•----------------"'"----------------------------------------------------------- ------------ -- '------- - 4 ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, SZilawnd rules and regulations of the San Joaquin Local Health District. (Signed)--------• --------------- ----• ------------------(Owner and/or Contractor) By:----- ----------- •--- --- ----------- - -------------------------- -----------------(Title)---------- - - ----------------(Plot plan, shf lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- -- --- DATE---------&=./P--_: ----------------.-.--------- + REVIEWEDBY------------------------- --------- - - - ---------------------------------------:----------------------------- ----- DATE--------------------- BUILDING PERMIT ISSUED--------- ----------- ---------------------------------------------------------- DATE----------------------------------------------------------- Alterations and/or recommendations:------------------ ---- - ----------------------------------------------------------------------•------------------------------------------ ----------------- ---------------------------------------------------------------------- ---r-------- --------------------------------------------------------- ------------------------------ --------------------------------•---------- . ------------ ------------------------------ ----- ---------------------.-.-...-----------------•------•---••----------------------------...---------------------------------------- . .------- ------------ f - d ---------------------------------------- ----------------------------------- -------------------------------- FINAL INSPECTION BY:------ i" ----- ------------- Date--------- S J AQUIN LOCAL HEALTH DISTRICT 1801 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.p.0 O.