21585 - Laserfiche WebLink

Home Browse Search

---.--------FOR OFFICE USE--.----.- � •� APPLICATION FOR RANI rFATION PERMIT Permit No. . ----------------.------------------------------------ -- (Complete inDuplicate) -------------'.,------ ------------- --------- Year From Date Issued Date issued This Permit Expires 1 Y Q(S-- @ww�- 030 °`0--5 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.t X272 N(' �� & /g 4'AV 3.) /:R- JOB ADDRESS AN CATION----S3� -�lX.�'Z- 1-_-- -- - .., '" - '. .---`-. - -� - Owner's Name------ - ------- ----.... Phone------------------------- Address------------ _ XZG'rfuf. .t• -------------------------------------- ------------ Contractor's Name---- --- "'``'� --•---- ------------ Phone--------- ------------- --- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ of living units: __1___ Number of bedrooms 3____ Number of baths _ '` Lot size _._y _' r�`-5�--------------------------- Number f Watei Supply: Public system ❑ Community system ❑ Private [Depth to Water Table -------- ft. --Q Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ N Previous Application Made: (If yes,date--------------------f No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes [I No ❑ Cl TYPE]OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se tic ank: Distance from nearest well....sO_�._--Distance from foundation------d._f... Material______ ._._.-_... p /T� [I� No. of compartments_.___y-------------Size-�__� r�-_qX�_1`iquid depth_.___-_�_-...__..._-Capacity_.1�_- . Dispos Field: Distance from nearest well_ 4" /---_Distance from foundation__-/A _l-------- to nearest lot line__---'r--........_ Number of lines--------.,7___-____________ ____Length of each line------�0------------------Width of trench.-.--_Z-_/----_-_---------_- Type of filter material_--_-_6,JZ--'-----_Depth of filter material-___-/_-f___:'-_____-_Total length_:_._ �_/---------------------- Seepage Pit: Distance to nearest well------- --------------Distance from foundation__--__---__----_-_.Distance to nearest lot line--_--_--------._- ❑ Number of pits----------------------Lining material--------------.--------Size: Diameter------------------.----Depth----...-------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_--:.._-----__-----_._----------.._-_. Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest bui{ding.---._-_-..--------_----_-_--_------.-_--- ❑ Distance to nearest lot line--------------------------------------------- ---------------------------------------------- -------------------------------- ----------- Remodeling and/or repairing (describe}---- --------------------------------------------•--•----------------------------------•---------•-------------'-•---------------------------------- ---------------••---------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------- ----- ------------------ ----------------- ------------------------------------------------------------ ------------------------- ----- - - - --- ------- -------- I 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)----------- -- -------------•_-_-- -- -_-- --- (Ow"r and/or Contractor) ------------ --- ------------------------------------------------ --- ------------------ ------------------ BY� r ----------------------- -----(Title)--------------------------------------------- .- -------------- (Plot plan, showing size of lot, location of system i"n refatian to wells, buildings, a+c., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY____ ----------------------- DATE----?- -4�,7-------- REVIEWEDBY----------------------------------------- -- ---- ------- -------------------- --------------------------------------------- DATE-------------- --------------------------------------- ---- BUILDING PERMIT ISSUED------------------ -----------t--------------------------------_.------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:-.-.----- --------s ............ ---------- ------------------- ' -------------------------------------------------------•------- ---------- --------------- -------- ----------------- ...... ------- - ------ - ---- ------------------ FINAL INSPECTION BY,�A,._ __ _ !Jeo_l- Date_ . . SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 F.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California - Manteca,California Tracy,California