19801 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: -------------- -- - ------------------------------ APPLICATION FOR '-;ANITATION:PERMIT Permit No. __ ., $Q_� ------------------ ---------------------------- -- ------ (Complete in Duplicate) - ------------ --- This Permit Expiresl Year From Date .Issued Date Issued . ��___'- Application is hereby made to the San Joaquin Local Health District for a permit fo construct and install the work herein described. - This application is made in compliance.with County Ordinance No. 549. _ . r ` JOB ADDRESS AND LOCATION__- _ -- �_` a- '•--------------- ------------ --- - r-•� - --- ------ -- - Owner's Name ' I� -------- Phone.-- !-------------•----------- Address_________________ I --------------•---••-•----------------•-_-------- Contractor's Name----------- -----------•----- Phone Installation will serve: Residence Apartment House ❑ f Commercial ©,�Trailer�Cour 0 +o!R ❑ Other ❑ Number of living units. _ __ Number of bedrooms,..__„N,umber of.baths J___ Lot size A 6;�_ � G� ------------ ------------ Water Supply: Public system P_00&mmunity system ❑ Private E] Depthyy to Water Table "OD ft. Character of soil to a depth of 3 feet:i Sand E] Gravel 0 Sandy Loam ❑, Clay Loam ❑ Clay ❑ Adobe lardpan ❑ Previous Application Made: [If yes,date--------------- -I No [4—New Constriction: Yes U?Iollo ❑ FHA/VA: Yes [�No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: iI f No septic tank or cesspool permitted if publi sewer-'is eweris"avail`able—wwi+kin'240 fee+.) '4 ( P P P < Septic Tank: Distance from nearest well____—�______Distancefrom foundation_, f - Mate �: .__-_. , No. of compartments---A---------- ..Size __ •___Liquid depth-___1 ---_----.-_-Capacity_��_______--_- $I < f� Disposal Field: Distance from nearest well._.' --------Distance from foundation._ ..:_.Distance to nearest lot line_______ [ � Number of lines___ ________ _ Len``th of each lin �. - --- ------ 9 A --�--v- ---.Width of trench-'�---------- - - ----•-- Type of filter material 1 / __Depth of filter material---/00____-------Total ___________________-__ I�� s s� < ✓j �, Seepage Pit: Distance to nearest well_- xr----------Distance f m f dion,.�a_-____-.Dis ar e to nearest to : i' e_Yo_ __ ----- at �. Number of p'ifs-- ffs.5------------Lining materkial- ' :Size: Diameter .__.._._.__.Dept Al�r�9 Cesspool: Distance from nearest well-----------------Distance from°'oundation_--.____.__.______..Lining material--- �. Size: Diamoter------ -------------------------------De th----_----------------- ----- --- . _Li uid`"Ce pacify- --------------------------gals. Privy: Distance from nearest well--------------_._._____l�------ -- Distance from nearest buiiding._. ------------------------------------- ❑ Distance to nearest lot line- ------------------ �� ---------------- --- ------------------- I------------------------------------ Remodeling and/or repairing (describe):--------- �� --------------- -----------------•------------------- ---------------------------------------------------------- r°------------------------------------------ ------------------------ ------------------------------------------------ ----------------------------------- - c ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------- -------------- ---------------- ---------------------------------------------------------- ------ ----------------------------------------------------------------------------------------------------- "'". I hereby certify that I have prepared this application and t9a+ the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and Tregulatiofnss of the San' Joaquin Local Health District. . �- - `hEr` 1` --- ------ -- -- -------------------------- t. (Signed)--- Title- s(�2�T'and'f or Contractor] 6��--------------------------------- ) ) = ---_.... _...--------- (Plot plan, showing size of lot, location of system in rel n t�wel , buildings, etc., can be placed on reverse side). I .,.�,._� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---_.6:f,0/Z-- --------------- ----------------------- DATE__ ---------------------------------------------- REVIEWEDBY--------------------------------------- ---------------------------------- ----------------------------------------------- DATE-------- ---•-------•---- -------------------------- :11 BUILDINGPERMIT ISSUED-------------------------------------------� ------------------------------------------- _ DATE----------------------- ------ .------------------------ Alterations and/or recommendations:----- 3--•-------------- G ..... _4K;-�------------------- � ii I -------- ---------------------------------------I------•--------------------------- ----------------------- --------------------------------------------- - ---------- w -------------------- -------------------------------- - ------ -- ---------- ---------------------------- ----- -------- ------------•--- FINAL INSPECTION BY:____-- Date__..,.. - -- r -------- ---------------- ' SAN JOAQUIN LOCAL HEALTH-DISTRICT.' 1601 E.Naielton Ave. 300 West Oak Street I 124 Sycamore Street.; t: 205 West 9th Street Slocklon,California Lodi,California I'd Manteca,'California-•' a Tracy, California r.P.0 C. �• Y J n� r