9422 - Laserfiche WebLink

Home Browse Search

1 tel'// APPLICATION FOANITATION PERMIT Permit No. _77..� Z-_ + i r ` k ,Complete in Duplicate] Date Issued /_. �. /:'.. r 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. -1--------------------------------------- JOB ADDRESS AND LOCATION--=--- ---21-31---E._...9�h -��.--�----='-•-•-------------------------------------------------------- Owner's N a ; ame ------------•-- Chaff• Freer Phone---��* .2y336.7_. Address------SM9-----------------------------------------`----------------------------- ---------------------------------------- ----------------------_-----------r-----------•----------------- - Contractor s Name----- Delta: ILO. ------ Phone_HD-•--- Installation t will serve: Residence a Apartment House ❑—Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __I__- Number of bedrooms __2_.- Number of baths ---I_ Lot size ---5n---$---1-.o----------------------------------- Water _____--_-_________--.--___._. -_Water Supply: Public system [2 Community system ❑ Private .❑ Depth to Water Table _5 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe® Hardpan ❑ Previous Application Made: Yes ❑ No M New Construction: Yes [I No ❑ PHA/VA: Yes ❑ No [I TYPE.OF INSTALLATION AND SPECIFICATIONS: ,+ (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Material---------<.--------- -------------------------- ----Size-------------------- - EXis'�ng No. of compartments-------------------- - -° ------.Liquid depth--------------------------Capacity----------------------- Disposal Field: Distance from nearest well------------------Distance from foundation-----'-------------..Distance to nearest lot line------___________ Exie ngNumber of lines-- -------------------------------Length of each line-�-----------!--------------Width of trench--------.--------------- ------ Type of filter material--------------------------Depth of filter material___.___".----------------Total length________-____.__...________-__________-.__ t � Seepage Pit: Distance to nearest well... ? e.___pistance from foundation-----ESPI-e.Disfance to nearest lot line----8_XP19 11, 1 n Number of pits---- material__rOG�i---------Size: Diameter___:$__-_____ f „ Depth �---•------------------- -. Cesspool: Distance from nearest well-_---------- ---Distance from foundation__.__"_`--------------- ___ ---_*Mining material----_____-_--___.__.___-_______--_ ❑ Size: Diameter---------------------------- ---------Depth---------- -- = Liquid Capacity gals. Privy: Distance from nearest well-----.------------------------------------------ _Distance`-from nearest building--------------------------------------- ClDistance to near t lot line---------------------------------------------------------=T-----_----------------------------------------- ------------------------------- Remodeling and/or repairing (describe):-----------$riding---B-G_eP , pi' -__ O_# x B lig--8 F3 ,@iII----- ------------------- - --- I 1 --- ---------------------------------------•----------------------,-----_----------------------------------------- --- A i , ---------------------------------------= -•----------------------------- -------------•------------- ---•--------------------- ' ---------------•--------------------------------•----------- i IL ------------ ---------------------------------------- ---• -- -------------- ----------------•--------------------------# ------------------------------- ------------------------------------------------------------- I hereby certify that I have preared this application and that the work will;beudone in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. Si Hari p@��as--...Inc.*nC:------- .--------- -------- (Owner and/or Contractor] BY:---------------------•-----------------PerrY--Wart-h�-= (Title) Gen plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY , APPLICATION ACCEPTED BY----- - -- ---------------------_----------- -----------=--------------------------- DATE 4 / r i- (.---------------x REVIEWED BY------------------------- ----�--`-�-------------------------------�-------- --- ----------------------------------- DATE-------- -= ----------- ----------•--- ---•------ BUILDINGPERMIT ISSUED------------IA---------------------------------------- " ----------------------------------------- DATE------------------------------------ Alterationsand/or recommendations---------- ---------------------------------------------------------•---------------•--------------- ---- ----------------------------------------'--------to ., ------------------------------:5:!':1 5 ---------------------------------------•-------------- ---•-------------------- -----;--------- --------------------------•----------- ------ --------•-- -- - ------•- -'------------ - - ----'----------------------------- ------ ---------- ---------- -- --- -- - -- --_•_----------- FINAL INSPECTION BY:.. --- Date"_ "_ �.. = -- 41 SAN JOAQUIN LOCAL HEALTH DISTRICT { 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California i ES-9-2M Revised 1-57 F.P.CO.