21285 - Laserfiche WebLink

Home Browse Search

FUROFFICE USE: 'i __-----------------------------_------------------- --------------------------------------------------- APPLICATION FOk-SAWATION PERMIT Permit No. c�Z�Q2. .... ----------------•--------------------------------------•- (Complete in Duplicate) - --------------- ------------------------------ --- This Permit Expires 1 Year From Date Issued Date Issued 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 compli nc� with County Ordinance No. 549. JOB ADDRESS AND LO- TION.F. �O— • SC� ----- •e.------ --h----------- Owner's Name............... �) r .........---•--------------------- --------------------- -•------ � --1--- - ------------••- - ------------ Phone.............----•-•---------- Address...................... ---•-----Address-----....-••-----•--•- / --------•------------------------------------------------------------------••---- --------•--------------------....------------•--••--------------•--- Contractor's Name -C----- �'{r ! Phone - ...----• ................—- ..._.... : Installation will serve- Residence 3 partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J_____ Number of bedrooms 2__- Number of baths -_4___- Lot size ........C_---�:L---- _____________ t s Water Supply: Publ:1depth 'system ®Community=system .[] Private E] Depth to Water Table 2A' ft. Character of soil to of feet: Sand ❑ Gravel ❑ Sandy Loam ❑{ Clay Loam [ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: I I f yes,date--------------------I No [ New Construction: Yes ❑ No p—FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND,SPECIFICATIONS: , cam„ 1 I (No septic tank or cesspool permitted if public sewer is available within200 feet.) Septic Tank: Distance' from nearest well_A2L4.=_Distance from foundation----X____`_-------Material-------4iax No. of compartments_____.. ......------..Size--------�s'� .i Liquid de #h--_____`145,—_.________._Ca Capacity �' � i. i v------------ q P P tY-.... ...... Disposal Field: Distance from nearest well-A42'- _Distance from foundation...1U.-_'--____Distance to nearest lot line.....:S L Type Number of lines.- ----------� _ ____Length_of each,line--------- f ------..----•Width of trench---------- p� SV filter material._-- ___. _ Depth offilterT a vial...-- --`_---'-----Total length............ U----------------------- Seeppq6'Pit: Distance to nearest well—AJ.............Distance fr m oundation... .0..__.I......Distance to nearest lot line__�.�.�____ ❑ Number of pits_________t.....------Lining,material_-_ �5ize: Diameter-__19_2_f.U.-------Depth----------:$_-_________________ Cesspool: Distance from nearest well--------------I_Distance from foundation...__________t____._-Lining material._._____-----._-____-______. --- gals. IT ❑ Size: Diameter.-----------•---------._ -__.Depth----- -----------�"-•---•------------------`---..Liquid Capacity------------••------------- Privy: Distance from nearest we11________________-_--__---____________.__.k- from nearest building------------.__________-----._______.__._. ❑ Distance to nearest lot line-----=------- ------------------------------- -•-------•--- ----------------- Remodeling •--------1 and/or r'pairing (describe / p 9 { 1 -----------------------F--••------------E ------ 1 -•---------------------• ------------------------------------------------------------------------------------------------...----------------------------- --•-------•-------------•--•--•------•----•------------------- '# i --------------------------------------------........... -------------------------•f-------------------------------- ----------------------..---------------------------•-------------------------••--------------- hereby certify that I have prepared this application and that the work will be done-in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) ------- ---- ---- --'---------------- ------------------------- ------(Owner and/or Contractor) By—.......------------------------ ---------- -------------------------------------------- ----------------••--.......(Title)---- -------•------------------------- ----------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). 1 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED ----- _ 1__ _..___� �--- -- ___ DATE----------- •---------------------------- REVIEWED BY- -- ----- ---------- --- - ---- ------------------- DATE _I : i BUILDING I PERMIT ---•-------•----------------------- DATE Alterat ons and orrecommendations:-------------------------- •--------------------------------- ............... . ; vf 7(� r.. C� �q .e----�-s = -• --- --u - - �-may- ms's -- �7 .slif 1,< f �7 /` " r %sem f 1� Q1 / f✓..��C•(�.' = --•--._ ...... FINAL INSPECTION BY----.................. -------------------------•- -------------- Date..------ 1,7- - - ----------) ---------/ ---- -------- ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak STreet 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-61 ATLAS