SU0012540 - Laserfiche WebLink

Home Browse Search

F R OF ICE USE; Permit FORsS4Nl �TTION PERMIT No.APPLICA _ --_ .--- .... .................... (Complete in Duplicate) t Date Issued .-•�- ... .. ....... . . . .... This Permit Expires 1 Year From Date Issued Application islhereby made to the Sari Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Or inance No. 549. > t q0 . :/If— JOB ADDRESS A LO T N.. . 1 ------• --......... Owner's Name / �Y = - ..,..:-._. . ...:_........._.__....-.._� r Ph '.... = one ---- Address._......._i - - ------_... .........................................� ..--- -. .. .. .. ...........•--- ..�. Contractor's Name----------------------- _.. Phone _.......... ---------------- -•---- ztalletion will serve: Residents Apartment Nouse ❑ Commercial ❑ Trailer Court ❑ Motel Q Other ❑ .. . tVLer Number of living units: /.... Number of bedrooms ._ Number of baths . .._.:_ Lot size - -.X/4D----- --------•----------- t - t Supply: Public system ;Z Community system ❑ PPtvete.❑ Depth to Water Table J��ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy LoElClay Loam [IClay C] Adobe Ig Hardpan ❑ Previous Applit cation Made: (If yes,date/gs-7 - --) No ❑ New Construction: Yes L] No FHA/VA: Yes j] No E]I TYPE OF INSTALLATION AND SPECIFICATION: j (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ,w t 04�nk: Distance from nearest well.......:........Distance from foundation-----------_�.....Material..._.:_..._ ---................................. ' 3 t - .-.Capacity. tfJo. of compartments................. .............•�-Size-------•--•.�'.a.`�........Liqu�a depth.............. . ---....--------�----- Disposal Field Distance from nearest well)2V1t9 ..Distance from foundation..�L�-�...--_Distance to nearest lot line_..S7...... Number of lines.....-.--. ----• Length of each line---- trench.. _.._ .Z..�---- Type of filteym4terial.s;. -:Depth of filter material_..f,t ...........Total length-------------- ..:..... Seepage Pit: Distance to nearest wel�_d.►�-�x' .Distance f om fo nOetion_ sP.-.......Distance to nearest lot fine�..`�_-..._ Numberi of pits,.—L--n------Lining materieL.7C +...Size: Diameter_T-.- '�Deptn-.--off S----•------------- �4 i ........Lining Cesspool: ='D-stance from nearest,well—. ...........'.;Distance from foundation.... . . tmaterial------------------------------------- �1) ❑ .t 's ►� , . .-...._ ... Depth . - Liquid Capacity------------------------•--9als. Size: Diameter --" . Privy: Distance from nearest well. -_ ..._.-.._.i_. ....Distance from nearest building ......................__..__..... ❑ Distance to nearest lot line------- I --•----------""•'---------------- Remodeling and/or repairin9"(desc-rite}_--�--_^"_r.,....,.,..._.�.--•-•-------- ---------•-•---•--..__............... ............ ................ ! t --•...................•................y..r•----• ...............................................••--•---•-------------......... t ........................................................... t --- -•--••-. i ..... ............... ....•--------• . - ...... ......•. --- -----•---••-•••-- -•----- -------- . - -- ....... -----•............ .................••------.................... ` I hereby certify that I have prepared this application and that the work*will'.be`done in accordlnce with San Joaquin County Ordinances, St I ws, an4 rules and regulations of the San Joaquin Local Health District. � t � �. .�, -•�•• �r..--'---- - caner end/or Contractor] (Signed) By:.................... ----- . - ........... the}_. .............. ...... .. (Plot plan, showing.size of lot, location of system in relati wells, buildings; etc., can be plaie on reverse side). I f FOR DEPARTMENT USE ONLY 1, r... . ... -.. ........................... DATE....... fr 1.-1--- APPLICATION ACCEPTED BY...._... __. I-�- REVIEWED BY..... -.....-..-•--------- 7'.... ................ .... ....... DA ........................................................... BUILDING PERMIT,ISSUED--.... " .�.�......--.. ._.... --- ......... •--•-•-•-- -- .DATE..............._.... Alterations and/vr,racorlgmendetions:..... 11�... •-••:-1 ` - �' " ""' cam.�>. _.. .� �e o ....._.�.��n4„LCL.,ti-............. .......-�:.. ,y�_iF__........._....-•--•-----..... -----•---•------- - AN e - - ..._ .....---•--....................................................... '............. ............ ...-......................... ......_...................... .............. FINAL INSPECTION BY:. � ' �--- Date......... ....................... / fANAQUIN LOCAL HEALTH DISTRICT 1601 E.Woselton Ave. 3k Street 124 Sycamore Strut 105 West 9th Street Stockton,Galifomia Lodi,California Manteca,California Tracy,California EG 9 N6V1660 a•99 3m 3-•G3 r.P.co.