3348 - Laserfiche WebLink

Home Browse Search

1 4 , *• �`� A1111CAT10N FOR IMITATION PERMIT Permit No. __43_3461(4(�•'-`; (Complete in Duplicate) Date i /y `��-� v ssued ____ ___� ----�• _ , �6 Amade to the San Joaquin Local Health District for a permit to construct and install the work herein described. pplication 1s hereby This e in compliance with County Ordinance No. 549. application is mad - .....0 ` lit 1c ._.._ _ + - _. ----------------------- -------------- JOB ADDRESS AND LOCATION_.N- --- ---- "'�-------- �,, ----=------ --------- - -- ----------- Phone- ----------- -----�=�`-`•��'� OwnersName--------------------------------- ---------•- Address__ r{-0 ._ .------ » Ci Phone---- " �Q pp ------ Contractor's Name----------------------------!_..-- .--------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ,K Motel ❑ Other.❑ Number of living units; -------- Number of bedrooms -------- Number of baths ------ Lot size _mrd~ - -- ------------- Water Supply: Public system:[] Community system ❑ Private Depth to Water Table,10 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam El Clay Loam ❑ Clay [I Adobe, Hardpan [Is� ' 1 � , Previous Application Made: Yes E] No JRL New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: , (No septic tank or cesspool permitted if public sewer is available within 200 feet.) tic Ta k:, Distance from nearest well-_______.---._--Distance from foundatioi__________________Material---.---_'___- ..._---_------.-__--.-.- No. of compartments—_--------------------Size---------------- ------•---- Liquid depth =-- --------------------,Capacity--------------- ------- p!posal Field: Distance from nearest well----- ..__--.-Distance from;foundatio --------------------Distance to nearest.lot line----------------- r Number oi.lines------------------------- ---------Length of each.line---------k-----=--------'-----Width of trench.-------------------------------• 6 v Type offilter meteria4_____-------------------Depth of �ilter 4 aterial__��-__'-��.,;Total length------------------------------------------ Type to nearest lot line_-_. Seepage Pit: Distance to nearest welL:,�QQ--------Distance from foundation.. '/ Number of pits----- -------------Lining material�C_ Sixe: Diameter__`e?!"-------.Deptle ----------------------- Gesspoal: Distance from nearest well from foundation------------------- Lining material----------------------.-------------- Cesspool: _.-.-- _-- r� '"� Li uid Ca acit gals. f ❑ Size: Diameter--=------------------------------- Depth------ ------------------------------------ q Capacity_ r Distance from nearest building ' Privy: Distance from nearest well ----- --- ------------- 1 s ------------ - ❑ Distance to nearest lot line----------------------- ---------- ------------------------------------------------- I r` Remodeling and/o'r repairing {describe}: - --------•----•-•----•------ •------------------------ ----------------------------T----------------------- ---- 4 I hereby certify t� 1 have prepared th6 application and that hath workLocal Heawill l be done on a}n accordance wit h San Joaquin County ordinances, Sta+e laws an rules and regulations of the San Joaquin :v r ' contractor) `i ---- ^ r ---- (Signed) 4 -- By:__-----------•------------------------------------------- �.. r_ ------------(Title)-----� �� - (Plot plan, showing size of lot, location of system i�r ation to wells, buildin s, etc., can be placed on reverse side). FOR PARTMENT USE ONLY APPLICATION ACCEPTED BY = __ DATE------/--�'--g- > 7--------------- - ---------- ------------------------------------------- DATE------------------------------------------------------------ REVIEWEDBY------------- -------------------- ---------�•------- =- ----------- ----------------------------- DATE--------------------------------- BUILDING PERMIT ISSUED--------- --------------------------------------------- ---------- ------------------------- Alterations and/or recommendations:------------------�`_--____. . --------•------------- -------------------------------------------------•-------------•-- ----------------------- -------------------------- -------------------------------------------------------•- --- -- -------------------------- ...-------i•--- --- - ----- Date_ > ---- -------------- -------------------- FINAL INSPECTION BY: SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street i Tracy, California Stockton, California , Lodi, California Manteca, California ES-9-2M 0-52 Revised W-2100