18467 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: 7- 2f y-------t�;, --------- -- , APPLICATION FOR S�INITA710N PERMIT Permit No. .... ? .�- _ (Complete in Duplicate) . Date Issued I J------------- -------- ---_. -._._ This Permit Ex ires 1 Year From 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. . - ------------------ JOB ADDRESS AND ATION_-_.-.--CC;I___ ---- /,, Owner's Name----------11J`? -------- -4 -- �•'_`i-'S ----- ------. Phone13U-$._CIU- .761 Addteactor`s Name_ .... ----------------- ----- -------------------------- = � � Co --- ----- ------------.. Phone_ 4f6P� Installation will serve: Residence K Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ f ; Number of living units: - _ Number of bedrooms --_ Number of baths - Lot size ---- ---------------_.--.-- . � Depth to Water Table Su'fIY� Publics stem El system ❑ Private Q ft. I Character of soil to a depth of 3 feet: 'Sand ❑. Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeX Hardpan ❑ Previous Application Made: {If yes,date_--------------=---f No X_ New Construction: Yes ❑ No [& FHA/VA: 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 foundation-------------_----.Material__--.- ---_--_-'-----..-____------..-.- 0fitS4Arw No. of compartments-------------- -„Size---------------------------------Liquid depth-------------------- Capacity----------------------- Disposal Field: Distance from nearest well_ -Distance from foundation_-_. 1�C1---------� Distance to nearest lot line-h5 _--__ Number of linesll_ -__ _��.----.--Length of each of trench-d__Z-. - ff Type of filter material-------------------------Depth of filter material-.___-------- ------Total length---------.--------------------------------- F Seepage Pit: Distance to nearest well--- Distance J�frq foundation_AQ_--__--_:Distance to nearest lot line--.- Number of pits._(JY _�l�__Lining material_ -y- KSize: Diameter-_---3--._.-_-------Depth.._2--; _ O Cesspool: Distance from nearest well----------- _Distance from foundation---------------------Lining material....___..__..------_--------_-__-- ❑ Size: Diameter-----------•------------------ - Depth--------------------------•----- -- ---------------Liquid Capacity..'-.----------------------- gals. Privy: Distance from nearest well------ .----------------------------------- _ Distance from nearest bui4din Distanceto nearest lot line_}----------------------- -------------------- --------------------- ----------------------------------------------_1----------- -------- I Remodeling and/or repairing (describe)_________ ______ fj' -------------------------- -------- ------------------- ---- • -------- -- -- __ -� ---- --- - -- ------------- --------------------------------------------------------- ---- ---- ---- ----- k I hereby certify that I have pr` ` this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules nd, re lations of th an Joa uin Local Health District. (Signed) ------ - ------- (O and/or Contract 9 )----------_------------------------ ---- gY (Title)- --caner ------- ---- - ----------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be plat on reverse side. t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- -_ [/S-------------------------------- DATE--------_- - --�-�- -_-�`� - --------- ----------------- REVIEWEDBY-------------------------- --------- -------------------------- DATE------- - ----------------- ----------- BUILDINGPERMIT ISSUED----------------- --------------- ----------------------------------------- ---------------r--- DATE------------------------------------------------- ------ Alterations and/or recommendations:-..--______--- ____ /---------------- -- L- ----•- / " �” f ------------------------------------ ----------------- -- �-= ..----- ----------. _ _ G ------------------------------- -----�----��-------------------------------------- - --------------------------------------------------------------- FINAL INSPECTION BY:- -------. Ga�t�� Date ------- ---- -- ----- -------------------- - AN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 00 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.co.