Laserfiche WebLink
FOR OFFICE USE: <br /> .teaLv Sffa Z-V.44 APPLICATION FOR iATION PERMIT Permit No. ...1��1 <br /> -------------------------- ---------------------- ------ (Complete in4 plicate) Date Issued ___....!_.._ ��/ a�-_­t_ <br /> - <br /> This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> -- -- <br /> �✓ <br /> JOB ADDRESS AND�LOCATION------- --- - <br /> Owner's Name 1 ---------•----------------------- •----------------------- .----• Phone <br /> Address --- 1-- ---------- <br /> { & <br /> - <br /> F <br /> �ZlF1 <br /> Contractors Name----l•-- Q----- ----------- opg-2/ Phone_...__..............__._... <br /> Installation will serve:- Residence ❑ Apartment ,Hose ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: J...... Number of bedroom`s;.__- Number of-baths--I=-U6t size .._ .-- sir,�f__f.Lr7�-�.__.--___.-_____-_ <br /> Water Supply: Public system �ommunity system ❑ Priva+e ❑ Depth to Water Tablets ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe lardpan ❑ <br /> Previous Application Made: (if yes,date_______________ -...} No New Construction: Yes �o ❑ FHA/VA: Yes ❑ No U_J�N <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool perhiitttitd if-public's ewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well__ '+' �:Mstance fro foundation__�U____' _.Ivlateriaf:,:�,rw°_ .r!.C_ --------------- <br /> No. of compartments- ------.�_...size-_..•.s - -��-----Lrquld ------ ----CaPau ty--��...--- <br /> Disposal ----- <br /> j <br /> Field: Distance from nearest wel{___"` '_._._Distance from foundation---/!'.A.-I .Distance to•nearest lot line.w <br /> Number of lines-----------_------_ -- 'Length of each line-------- ---3__f__.Width of trench_`cp.__!d__ ----------- <br /> Type of filter material__._.)&__r1�D­6pth of f{ter material___ _._-.--Total length---------3I 2�__-____-_-______-__ <br /> Seepage Pit: Distance to nearest well-----�____-.Distance fDistance to nearest lot iine__�...._____. <br /> Number of pits_______,_____________Lining material____k-A.� ____.Size: Diameter____�.3-1.....Deptl�____.�-�_ _----------- � I <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material___.__.-____-._-________.__--_.---_-_ i <br /> ❑ Size: Diameter--------------------------------------Depth---- ----------------------------------- -----------Liquid Capacity.................. ----....gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--------._._.-_-_-____________---------_-. <br /> ❑ Distance to nearest lot line------------ ------------------------------------------•---------------•-------.-_-----------------...--------------•-•-------------------- <br /> Remodeling and/or repairing (describe):---------.L�_J /<---4/c-J/ ,��----/ __IV4G f 9--_._._-_h Q0--•--------••-•--------•-••- <br /> ______________________________________________________________________________________________________________________________________________________________________________________________________________________________ <br /> -------------------__--------------------------------------------.-_-_-_-__-___-_______-----------------------------------.------------------------------------------------------------------------.------------------------- <br /> I <br /> -_--____.._. __I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health°Dis+rict, <br /> �s" - - --f-- ------------------------ (Owner and/or Contractor) i <br /> (Signed) .Q7_el r <br /> --------------- <br /> (Plot plan, showing size of lot, location of.systom;in relation to wells, buildings, etc., can be`.placed on reverse side). <br /> s <br /> 4FOR-DEPARTMENT-USE ONLY <br /> - ----- DATE I <br /> APPLICATION ACCEPTED BY------ --- --�------- •` -- - - -------- ------------------- - ------------------ ----------- <br /> REVIEWEDBY-------------------- -------------------- ----------•---------------------------- -•-----------------------•------- DATE------------------ •-----------------------------•-•-------- <br /> BUILDINGPERMIT ISSUED------------------------ ---------------.-------------------------------- --- -•--------------------- DATE------ •----------------•••----------------------••---------- <br /> Alterations and/or recommendV"&,___ _---- -- -••-•-•-•------ <br /> rl .3 t ------ -- 01 <br /> __________________________________________ _ _. _ _ __/_____J�.A- -------------------._____._---_-__________-_______-_..___---.---_-_______.._-___----____.._ <br /> -----------•--•------------------------------------------------------------------------ <br /> FINAL INSPECTION BY:.- Date l ��� ' --------------------------- <br /> SAN JOAQUIN LOCAL HEALTH,.DISTRICT <br /> 130 South American Street. 300 West Oak Street 124 Sycamore Street 205'West 9Th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> r <br /> ES 9 REVISED 8.59 2M 5-62 ATLAS <br /> t <br />