Laserfiche WebLink
FOR OFFICE USE: Q <br /> --..__._--__.-------------------------- --------- APPLICATION FOR i5ANIT-ATION PERMIT Permit No. ..�r12-SP1 <br /> ------­------------------- ------ <br /> ------------- - (Complete in Duplicate) <br />----------------------- . ..--- ----- -- i This Permit Expires 1 Year From Date Issued Date Issued _-.: ---`� <br /> 141 <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 /> JOB ADDRESS AND LOC TION-- -- ---- --- --- ----------''--------- ----- # `------------------------------------- <br /> Owner's Name------- .- Phone <br /> o� i ,� <br /> Address 1 --------------------------------- = --------------•-- .................................--------- <br /> Contractor's Name------ -a= i .----------•-•----------- ------------------------------------- •---•---------•------•--- Phone..------------------------------•- <br /> 00 <br /> Installation will serve: Residence N] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: 11----- Number of bedrooms -------- Number Number of baths-------- Lot size ----- --- -------- -------- -------------------------------- <br /> u <br /> Water Supply: Public system ",❑ Community system ❑ Private ] Depth to Water Table .- ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay LoamE Clay ❑ Adobe❑ Hardpan l.-4 t <br /> u i <br /> Previous Application Made: (If yes,date------------------- ( No El New Construction. Yes F] No ❑ FHA/VA: Yes El No El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) _ ..-. <br /> Septic Tank: Distance from nearest well-------------- Distance from foundation----------------.-- Material ---------------------_. <br /> -__-_-------------_-_ <br /> ❑ No. of carmPartments--------------------------Size-------------=------ -----------Liquid dePth_________ ____ _ -- ____CaPacity--------------------- <br /> -- <br /> Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line----------------- <br /> F1 Number of lines-----------------------------------Length of each line-- ----------------.----------Width of french----------------------------------- <br /> Type of filter material.------------------- -Depth of filter material----------------------- otal length---.---..---_-----------_--.------------- <br /> Seepage Pit: Distance to� nearest well......._______________Distance from foundation--------------------Distance to nearest lot line----------------- <br /> ❑ Number of�pits--- ----- Di <br /> ------Lining material---------------- ----- Size: ameter.----------------------Depth------------- --------- --------- r <br /> Cesspool: Distance from nearest well ----------------Distance from foundation........-----.--- . Lining material--------.--------------------_-------. <br /> ❑ Size: Diameter- -- - ------------ ---------------Depth--.--------- ------------- -- ------- ------- Liquid Capacity--------------------------.-gals. Y, <br /> Privy: Distance from nearest Well---------------------------------.-.------------Distarce from nearest building.-----------._____---------------------- <br /> ❑ Distance to nearest lot line --------------------------------------------------------------------- <br /> g an - <br /> Remodeling d repairing describe): ,� - ------------------------------------------------------------•--------------------------------------••---------------- <br /> /or P airi91 <br /> M i <br /> I� <br /> _ II <br /> - --------------- ---------------- <br /> I herebycertify ---- <br /> 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 District. <br /> (Signed) {Owner and/or Confractorl <br /> By:------- y'�'""" -------- --------------- ----- --- ----------- (Title)------ --- - ----- <br /> `'-(Platoplan-sowing size' loPlr(d-c-atiW'&f-s�is-fe-m-in-r6lifion-f—o wells, buildings etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ------ DATE-/ _4....a-7- ---------- -------------- -- <br /> REVIEWEDBY m1-----------------.................... ------ ---- ------- -------------------------------------- DATE------------- - ----------------------------- <br /> BUILDINGPERMIT ISSUED------it--- ----•-- -------------- -­------------------ ••--------------------------------------- DATE-------------------------------------------------------- <br /> Alterations and/or recommendations:-------------------------- ---------- ---- -------- -------------------- ------------------------------------------------------------------------------------- <br /> y I <br /> ------------------------------------ --------------- ------- -­--------- -. ---------- ............. --------------------------- ------- - <br /> ---- ---------------- <br /> ,i <br /> -------------------------------------------------------------------------------------------------------- ------------------------- ---------- ------ <br /> Ii <br /> . .................--- ---------- E -- ------------...................... ----------------- ---------- ----- <br /> �i , <br /> A04af-44�_ ----- - -- ---------- Date--- ------------- - ------ ----------------------------- <br /> FINAL INSPECTION BY:.__- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> li <br /> 1601 E,Hazelton Ave, �i 300 Wed Oak Street 144 Sycamore Street 405 West 9th Street <br /> Stockton,California Lodi, California Manteca, California Tracy,California <br /> E.H.92M 1-67 Vanguard Press I! f <br />