9200 - Laserfiche WebLink

Home Browse Search

r Permit No. _.. - --¢--� t-APkICATION FOR „.,NITATION PERMIT (Complete in Duplicate) Date Issued ---- lirca4ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. `disapplication is made in compliance with County Ordinance No. 549. ' -----------•:------- JOB ADDRESS AN SCAT , - Phone _ { Owner's Nam ---------•----..---- _ Addresses -----' -- .. --- --••-----� - ---------•--•�------•--------------------------•-----------------•--------------------------------- - =-�----� •----- ------------ ---- .--- Phone - ' Contractor s Name_______________ ____ - - ----r--- ------ ' Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑,,,Y. Installation will serve: Residence Apartment House ! - r Number of living units: -_----- Number of bedrooms - Number of bath s Lot size __,!._ - - ------------ Private� Depth to Water Table -- ft. Water Supply: Public system ❑ Community system ❑ Adobe ' Hard an Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ / \� P ❑ Previous Application Made: Yes ❑ - No� New Construction: Yes* No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: / ' ' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) /� Distance from nearesr well--_5�-�-__Distance from foundation---/1.3-----------.Material---ec, ------•- -- Septic Tank: ,?(. -------Liquid depth------------ -------------Capacity./-Z:;V ❑ No. -",W- of compartments_-.-- -----------------Size-- --_ pisposaI Field: Distance from nearest well-----------------Distance from foundation-------------f-.....Distance to nearest lot line_____:__.____.__. µ Number of lines' ---------Length of each line------------------- -Width of trench ❑' Type of filter material-------------------------Depth of filter material------.---------------Total length-----------.------------------------------ k f le Seepage Pit: Distance to nearest well______________________Distance from foundation__.___.____.___.___.Distance to nearest. of ine___________.____ .Size: Diameter -------------Deptn= ' t ❑ Number of pits---------------------- ylA�3 fnaterial.--------------------- f 4 ining material, esspool: Distance from nearest well__ _Distance mrfoundatio Li uid Cara—6.t .r gni Q # ? K=-= - _Size: Diameter �,�_:_ f Distance from nearest wei4--------------------- Distance from nearest building-------------------- Privy: .. ----------- ---------- ❑ Distance to nearest lot line------------------------ Remodeling an or repairing {descn e� aid --- eAr - f , I_ _ . ax I herebycertify that I have prepared this application and that the work will be done in accordance with San Joaquin County ------------------- ordinances, tate laws, and rules and regu tions of the San Joaquin Local Health District. �o- 1 {Owner and/or Contractor] --------•-------- ------------ (Signed)---- Title __.--- 1 , ` By:--------------------- . (Plot plan, showing size-of lot, location of system in relation to wells, buildings, etc., can be plat d on reverse sig r FOR DEPARTMENT USE ONLY . DATE --- APPLICATION ACCEPTED BY-------------------- ---------•------------------- DATE REVIEWED BY------ , --------- -------DATE BUILDING PERMIT ISSUED__--_ ___- . Alterations and/or recomme . - [.tea"-�--� � �-sem-- --/�" ��,�• y��. .J ------- ----- ----------------- - -------- K1Date.... ------------------------------------------- F1N ECTION BY.---- , - ----- ----------------- R "Al . SAN JOAQUIN LOCAL HEALTH DISTRICT 1 AA 300 West Oak Street 132 Sycamore Street 814 North "C" Street South American Street Trac California Lodi, California Manteca, California Y' jtoekton, California �- r 145446 ATW pOH