2169 - Laserfiche WebLink

Home Browse Search

APP!ICATIOC OR in Duplicate) PERM,ITII �FTP it No. crs_I / r I } P 4V oa Issued Ato s--Z 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 S49. JOB ADDRESS AND LOCATION___' LIA----------- -- --------------------- ------------------------------------------------------- - Owner's Name--------- - �---- --- -------- -------------------- ----------------------------------------- Ph Address r one ---------------------- --- ---- n - '' D- ---- - Contractor's Name-------- Phone__042 Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number-of living units::-f--- Number of bedrooms Number of baths _ ____ Lot size __ � e) --------------- IWater SuPPIY FPublic system � Community system ❑ Private ❑ Depth to Water Table ft. G Character of soil to a depth of 3 fee_f: Sand ❑ Gravel ❑ Sandy Loam Clay Loam E] Clay [I Adobe�ardpan ❑ Previous Application Made: Yes E] No New Construction: Yes [ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: # (No septic tank or cesspool permitted if public sewer is available within 200 feet.} Septic Tank: Distance from nearest well-----------------Distance from fou dation__ �a No. of co -- - -------.Material__t . . .�x ----------------- ---- g-ipartmen#s______-_ Capacity, -------- Size---- -� � - ---Liquid depth--„�--- Disposal Field; Distance from nearest wellp y' ________Distance from foundat' JQ Distance to nearest lot line Number of lines--__-_-- __-- --- - -""---- ' Len th of each line_ - _ ------ g �: Width of trench_ _ ------------------------ Type of filter material___ _Q____ Depth of filter material__- -----------Total length-----�Q--------------------------- Seepage Pit. Distance to nearest well______________________Distance from foundation---------____---___.Distance to nearest lot line--'-- ----------------------- _________-_ ❑ Number of pitsLining material-----------------------Size: Diameter___-_______ Cess ool: Depth --- P 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------_-- g__ _____________ ------------------------------------------ ---- _----- / --------•--------------------------------------- Remodeling and/or repairing [describe]:_____-- %fl- � .-------•---------------- -- ----- -------- ------ ------ ----- ------ -•-- -- --- --- -- ---------------- -- --- ------ -------- - --- - ---- - I hereby certify that I have prepared this application and t of fhe work will be done in accordance with San Joaquin County ordinances, State laws, and rules an 'regulations of the San Joa�uin Local Health District. y� ,. (Signed) 7 o A 4 0 � .- -�... - -------------(Owner_1__.__ ?; '"n r Contractor) . O er and o C or) (Title)__- __ .-P- (Plot plan, showing size of lot, location',of system in relation to wells, buildings, etc., can be placed on rev a side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - z x_f.? '' REVIEWED BY DATE ------------------ ---------------- -------------------- .-. . , BUILDING PERMIT ISSUED---------_4444,0” = t'` •,f . -------- --------- ----------------- DATE- ---��-r--_---.-=--- ---�'9'- DATE--/......... - R....� Alterations and/or recommendations_ --"--------------------------------- --- jjj FINAL INSPECTION BY:----- - _ r- -------------------- Date-------- r _ # _ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street Stockton, California M 814 North "C" Stroet_ Lodi, California [ Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2100 [