22168 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE; --------------------------------------------------------- -------------------------------------------------- APPLICATION FOR< SALTATION PERMIT Permit No. ---------------------------------------------------- (Complete in Duplicate) p Date Issued -------------------------------------- This Permit Expires 1 Year From Date Issued �j Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work h rein described. This application is made in compliance with County Ordinance No. 549.. JOB ADDRESS AN b LOCATION -- --- ,S'/.. � ♦ f h7t.�4�* �D} �' 'r�"""" ��'�� Owner's NameV�1 - • •------ Phone Address-----•- f� r� = - ------------------------------------------------••-----------•----------------------------------••------••--------------•-•------- Contractor's Name----,/ e-I&�- e0%o�'----------------- ------ Phone------------------ -------- Installation will serve: Residence// Apartment House E] Commercial E] Trailer Court E] Motel [-] Other �) Number of living units: -l---- Number of bedrooms 2--- Number of baths _V___ Lot size------------------------- on Water Supply: Public system ❑ Community system ❑ Private Z�Depth to Water Table 'ft. Character of sail to a depth of 3 feet: Sand ❑ Grave; ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe Hardpan [ Previous Application Made: {lf yes,date--------------------) No FTrNew Construction: Yes V� o ❑ FHA/VA: Yes R4---No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tan Distance from nearest w IL.f/i*�..___Distance f m foundation/A________-Ma�/L __ 4�5'T/.._._.. h No. of compartments_ ------__-___---_$ize -----. , Liquid dept}7__ Capacity v-. �y p y Disposal Field: Distance from nearest well/.`_-Distance from foundation-� ------Distance to nearest lot line----------------- ®� Number of lines---11 ....... ength of each line_/Z9.��_--------- Width of trench_,Z/------------------------- � �? Type of filter materia/_ � _Depth of filter material_._ --f-_Total length, l7&6------------------------ Seepage Pit: Distance to neares ell_ ....Distance f fo ndation--- ____._.. s to nearest t Iil___."! ®� Number of pits...__---_._.._Lining material . - p $ize: Diameter - De th Cesspool: Distance from nearest weld-----------------Distance from foundation....................Lining material----------------.-------..-_.____...e_� ❑ Size: Diameter- -------------- ----- ----------Depth----------------------------------------------------Liquid Capacity----------------------------gal T1 Privy: Distance from nearest well----------------------------------...---........-Distance from nearest building._____--.-_.__----.-.-----._--_-----.._. ❑ Distance to nearest lot fineA/'/ --------------------- ----------------------------------------------------------- ------- ---------------------- Remodeling and/or repairing( describe :. ,f'./ N ----------------------------------------------------------------------------------------------------------- ---------------------------- ----------------------------------------------------------------•-------•------------------------------.---•--•-------------------------------------------------------------:--------------- 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. �p (Signed)____________________ __ 6r _! __! - /` _._.. . -�or Contractor) By:---------------------------------------------------------- - ---- -- - ------------------------------------{Title)-- .-/ y ---- - ---------------------- (Plot plan, showing size of lot, location of em in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- -- -------------------------------------------- DATE--4-7- --------------------------------- - REVIeWED ---------- --------------------- REVIEWEDBY------------- ---------- -------- --- ------------- ------------------------------------------------------------------------- DATE------------------------------ BUILDING PERMIT ISSUED------------------ -------------------------------------------_-------------------------------------- DATE------------------------------------------------------------ Alterationsand/or recommendations:-------------------------- ---------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------- ---------------------------------------------------------------------------------------------- ------------------------------------------------------------ ----------=--=-- ---- ------- ----- -------------------------------------------------------------------- -------------------------------------------------------------------------------------- -••-------------- p 7 FINAL INSPECTION BY:./"/� . . . -,t1 ---------------- bate_.4?_-_ _.4f---...--------------- --------------------------- SAN ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California