SU0004717 - Laserfiche WebLink

Home Browse Search

-------------- PLICATION FOR SANT TION PE. IT Permit No. -------. ... .................. . .. . ........................._. - .... . (Complete-in Duplicate) _.. _ Date Issued -------- ........... ...........-............. This Permit Expires 1 Year From Date Issued 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 compliant with County Ordinance No. 549. �SCAL0l� L�lr ` JOB ADDRESS AND LOC -51-Q --` E-1 1 �zV�.—_____ --/!7_--.n'►'✓��t F._--�� dE - ........ Owner's Name------------- .. I-EM..K V( j- --•---..__...._ PhoneSW7 2I-06.----.. Address................. E ---- ................ --------- Contractor's Name...... ...... .-•---..................................... --•-•- ............................................... Phone---................................ Installation will serve: Residence gT-'-Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -- l._. Number of bedrooms _2—.. Number of baths _/---_ Lot size __. ........................ Water Supply: Public system ❑ Community system ❑ Private (Depth to Water Table ._.... . ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam lay Loam ❑ Clay ❑ Adobe ❑ Hardpan [ � Previous Application Made: (If yes,date.._ I No ff�New Construction: Yes ❑ FHA/VA: Yes-R�No ❑ r TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T Distance from nearest well ___----5 Distance from foundation--------AQ----- Materia .Cd NCR. -TJFZ�..-___.. No. of compartments � �/_ I_V.X_�Liquid depth _.._�,/ Capacity---f.Zr.�-.0__ v P .�.-._....._.Size-f / _ Disposal Field: Distance from nearest well.-... -_Distance from foundation---------/_0---.Distance to nearest lot line----S__._..- Ic � i Number of lines __.--_.-_.__�--------------t.-_Length of each line----------- .......... of trench. _._.__�___.�-_...._..._.. cn /c Type of filter material----l��_ ...Depth of filter material-__-- --___..-Total length__- __ ___- --_ _. .___-.-__---.-__ Q Seepage Pit: Distance to nearest well .._A9_0-----Distanc from foundation----- ....._..Distan'cee to nearest lot line..-._.--_.- ❑ Number of pits-_. _.. !_.___-__.Lining material_ ��1` -_ Size: Diameter-_ - _.. _ . p De th.--_/.._3 Cesspool: Distance from nearest well -----------------Distance from foundation.-............... . Lining material----------------------------------.-. El Size: Diameter. .. .------------ --_ -- -------Depth--------------------------------------------------- Liquid Capacity.......................----gals. � Privy: Distance from nearest well-.---------------------.........................Distance from nearest building----__--__-•--.---_--_._-_-_-_._____ _ ❑ Distance to nearest lot line_....------•..................•---------------•-•-•-------•----------•----••--......-••---............................................. 1 C Remodelingand/or repairing (describe):................. -----------•-•----•--•-- ••-••-----•---••-••----•---•-----•-•-•-----••-••----••----------•---•---•--•••-•--••......•--•--------.....__. - -- ------------------------------------------------.... ..................................................................._--------------------•---------------._...--------••-----------------•-------•-------•-------- t ---------------------------------------------.........................................---•-----••-•------------------•---...--•--------------------•------------------•--•-----------------•-----•-•--•--......._......-_ -----••...............................................................-................................................. .................................. ------------------ ............................... 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, a d r sand egulations of the San Joaquin Local Health District. v ..............................................------(Owner and/or Contractor) (Signed)•------�------•---- ----- -_---------------------• - - By:....................................................................................... --•------------ - ............(Tiifle)---------- ------ ------- - -------- - - _ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---..- .T CR,'o-------- .........................._............................ . DATE.- ----- REVIEWEDBY----------------------------------------------------------------....................=-_---•--------•--------•----•••---- --- DATE............................................................ BUILDINGPERMIT ISSUED------•--•-•--•---•------------ ............................--------------------------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations: ---•--------.--•--.....---•...........................................-----------------__ ------•...----•-•••-----•--•--•-----•-•-•---------••.............-•---- ..---- . • ------ ----------- -------------------- . -- ----•..........•------------••--.....---•----•--•------......----------•-•------- --......................................................................... ...............................................••--••---•--------••••----------..................................................... ------......--------•--•---•-------•--•--......••-•-••...._............-----....--•... ------ .........._.....................•--•--..... - `.. ............................ Li FINAL INSP _ ' Date ................. .`./. -` SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Noaelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi California Manteca, California Tracy,California E.H.92M 1-67 Vanguard Press