Laserfiche WebLink
4 -,+ i rry�w s -4 r«rrx.,�w,k'� aiJ'.• -7 +. (Ke f"c ' -..;�{+�s. '�` pi y( - <br /> I <br /> ---------- .. <br /> ---`--_- ------------------- -------------- hts Permit Expires 1 Year From Date Issued <br /> -� Application is hereby made to the San Joaquin Local Healfh 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 LOCATION.. '-----------------------------------------------•---------------------------.... <br /> Owner's Name------ � __ '_ <br /> " ------- ---- <br /> - ------------------- <br /> Address <br /> ----- --- <br /> Contractor s Name---------- ---s , ; s ---------------------------- --------------- Phone--------_-.---------- <br /> i Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑,, Other ❑ <br /> 1I I Number of living units: _ ___ Number of bedrooms __ Number of baths _/___ Lot size _/__ ________________________________ <br /> �r <br /> r Water Supply: Public system ❑ Community system ❑ Private Rr'_Depth to Water Tablej-411074. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[B"'Hardpan ❑ <br /> Previous Application Made: (If yes,date--------------------) No New Construction: Yes ❑ No [� 'FHA/VA: Yes ❑ No.?- <br /> -- TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Se tic,Tanki Distance from nearest well_________________Distance from foundation--------------------Material--•---------------------------------------------- <br /> loerlltf No. of compartments---------------- _Size_______________-_____________Liquid de th__.______-__._._._ _Capacity <br /> n Disppsal Neld: Distance'from nearest well.. _____.Distance from foundationN-----------Widtnce to nearest lot line___ ... <br /> - <br /> Number of lines_-_•------,r✓--__--f_.__-------�Length of each line--- h----��-----------------------___-- <br /> Type of filter material---1-k4 _Depth of filter material___ ��_.-..Total length__-,-?a-_.:_,_____________________ <br /> 01 1�__--__.Distance to nearest lot line__l��r <br /> eepage Pit: Distance to nearest well___,� �a___:___Distance from foundation___. ------- <br /> W___ <br /> _____W___ Number of pits----- -------------Lining material_/Zr _..Size: Diamete __.._--De th_,�,.�` ________________ <br /> P \ <br /> V Cesspool• Distance from nearest well-----------------Distance from foundation--------------------Lining material-----------------------.-.__________- <br /> ❑ Size: Diameter-,__,:---------------------------Depth-------------------------------------- ------- -----Liquid Capacity----------------------------gals. <br /> IPrivy: Distance from nearest well-------------------------------------------------Distance from nearest building._________________________________-_____. f <br /> ❑ Distance to nearest lot line---------- �--------- •__F----------------------------•--••------------------------ <br /> Remodeling and/or repairing describe f ------•---------------------------------•- <br /> --•------- ------=------------------------------------------------------------------------------------------------------- - ------ ----------- •------------------------------------------------------------------ <br /> -----------------------•-...----------------------------------------------------------•------........--------------------------------- <br /> : ---------f----------------------------- --------------------------------------------------------------------•-------------------------------------------------------------•----------•--------------------------------------- I <br /> hereby certify that:l 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 /> v <br /> (Signed) <br /> f es = --`�m /or Contractor) <br /> $Y :`%��wells, <br /> � - ------------------------(Title)r�` C� ' <br /> (Plot plan, showing size of lot, location of system iin r I buildings, etc., can be placed on reverse side). <br /> F r` <br /> F FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY___(�---- _____________________________ <br /> DATE - ----------------------------- <br /> REVIEWEDBY-------------------------------------------- ------------------------------------------------------•- -------------------- DATE--------------------•--•----------- <br /> BUILDING PERMIT ISSUED-•--------------------------------------•--------------------— -------------------------------- DATE------------------------------------------------------•----- <br /> Alterations and/or recommendations:---------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------- <br /> _____..____________-----------------'----------------------------------------------------------------------------------------------------------------------------------------------------------------------._______________.- <br /> J -------------------------------------------------------------------•------..._'--------------------'--"---'----------------.•-------------------------------------------------------------------------------------------"--- <br /> FINAL INSPECTION BY:._.- `� ' � f a------------------------------ Date--- �'-=--- 7= ` " ------------------------------------•-------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street ..1 24 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California. <br /> ES-9 REVI9 ED 8-$9 f,P=. 2M 6-64 / <br />