14432 - Laserfiche WebLink

Home Browse Search

FOROFFICE USE: ---•----------•----•..................................... ------------------------------------------ // A �NCs!TION FOR ANITATION PERMIT Permit No. ..f.:7 ...:. .Z� ------------------------------ -------------------------- (Complete in Duplicate) -------------------------•• ••--.-••.-----••-•--••----.... This Permit Ex ires 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 compliance with County Ordinance No. 549. � .� 4,�,� YA JOB ADDRESS AND LO ATION__.... .^.- ;-- '� Owner's Name. = ......... 7— one.... .� .E.. Y2� Address....- .......... - �.. .,1 .A-- ..... ..� ,.�, ,... ..r .... ..... Contractor's Name... .........................• -••-•----------------•--...........------.....-----......._••---•............. Phone.................................. Installation will serve:. Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other 0 - Number Of living units: ...._._. Number of bedrooms .__..... Number of baths ........ Lot size ............... �� .......•................... Water Supply: Public system ❑ Community system ❑ Private 5 Depth to Wafer Table Z... ft. Character of soil to a•depth of 3 fe is Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0 Hardpan ❑ Previous Application Mader (if yes,dbte----_-------------) No [a' New Construction: Yes p No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND'SPECIFICATIONS: i (No septic tank or cesspool-perrniffed if public sewer is available within 200 feet.) � SAptic Tank: i}isf6r ce from. nee estwelt'___ Distance from foundation_.._/.......Material....... f * ( No. of compartments '.:2 .....size.......f. .7t .Liquid depth.---...h/.............Capacity..,.r0 � Disposal'`1=ibId: Disfen�`ce°frorr na st well-. � _ .Distance'frorn foundation..._3. .._--.Distance to nearest lot line................. Number of lines--------------{- ._.µ. .----Length,of each line...._---.� __Ct-.-.•Width of trench...._._..2�..__..:.....--•• Type of filter materi Depfh�off filter material !..'._.Total length._..........j ZA--2.,.Q......._... Seepage Pit: Distance fie nearest well -............ ..•_-pstance fromlfoundation ...... Distance to nearest lot line................. ❑ .# Number Lf Pik .��t*e Lining material.. ..-----•----.Size,Diameter. ` '.....Depth................................. CessPool: apea est welDistance fou dation�-!m.-- .... -.Lining material l.....................................pSize: ----' � .'Dpth............. ......................... ---------Liquid Capacity............... ............gals. Privy: sN%q WistanceNrom yneares4'well--... �-,.----._-_W.........��..---•...•DistanI'M. from nearest building x . 1 ❑ Distance to nearesf lot,line-........ _._ x_.. ........-•-----•.................................•-•_..... Remodeling and/or repairing [describe j� .......... `= --•--•-•------ G"�``-�-�- •......c) . xr_ -- �.,, --------- -------------------- ------------ . 1 ---------••---- ........------•�-•----._......................-•-•- •-".................... ------••-•••----•.._.. ' I hereby certify that,)~have`'rpr'eperec� this ipplication and that the work will be done in accordance witli'San Jo q in'County ordinances, Sta .laws, Ad ruV- e.� es and regulations of the San JoaquinLocal Health District. • — -r Si ped -, ....---...-•-•-- ( 9 )-- Cil -- ---•••-•-•............._(Owner and/oriContractor) By:............. ... ...... ` .... ....... (rifle)..........................................-.. .. .-.- (Plot plan, showing size of lot, location of system relation to wells, buildings, etc., can be placed on reverse side). 1i • t. FOR DEPARTMENT USE'ONL*APPLICAT ` ------ -REVIEWEDON BY.AC. EPTED BY �.- ... R, --— ---------••-------�-------�„-,.�3DATE----- �...f.?---•• ------------------------ �_ --------------- - -----•-•-• -----•-----.. DATE-•.......................... BUILDING PERMIT ISSUED __.. .. - ......--•--•---••-•-• D�'f4TE I Alterations and/or reco endo 'ons•_-------------------_____ ` _-__ ____________ - -J . :... ••. -•........._ �- ----------------••--•---------•..............................I........................................ .....................................-...------ --- ------- ------ -- ------ ----_------------.. ... FlNAL INSPECTION BY:....... ..--- ......_. .- ..................... ��, Date..----------I. 4- \ Date JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 144 Sycamore Street 705 Wast 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E6 9 REVISED 6.89 BM 6.61 ATLAS