SR0079728 - Laserfiche WebLink

Home Browse Search

r1JK UP-t-It-t Ubt: - I ------ -------- ---- -- - - . ..... . ...... ...._ . APPLICATION-FOR"�A'NITATION PERMIT r Permit No./ .. `' (Complete in Duplicate) , This Permit Expires 1 Year From Date Issued Date Issued�Q-_ly_- .5 Application is hereby made to the San Joaquin Local Health District for a permit " This application is made in compliance with C rtfy/q dhtance No. 549. to construct and install the work herein descrdescribed.f{� t JOB ADDRESS AND LOCATION__),( Owner's Name...... _/ t -- Q « .__. Address----------- •------ -------- Phone................................. ----I�, Q�.... Q ------------------------------------------------------------ ......... Contractor's Name__.._...._. _ --•-•--•----•-------------- ---AAe- ............................. - ------------------------------ Phone---._._............................ Installation will serve: Residence g?"oApartmont House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ElNumber of living units: . I �.- Number of bedrooms�.. Number of baths �-- Lot size Water Supply: Public system D Communitysystem y ❑ Private 2;-'15epth to Water Table Character of soil to a depfh of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay❑ Adobe❑ Hardpan ❑ {� = Previous Application Made: (If yes date- I No 2?"r New Construction: Yes U?*ro ❑ FHA/VA: Yes ®— No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well -�-"Distance f om f undation_ / No. of compartments.. ti'�.-" Size1�� !�squid depth.... f.- --------Capacity/�� Disposal Field: Distance from nearest well..4W_D stance from foundation__ do 7 �f �Q...___....Distance to neares Int line___47."_ ®� Number of lines_Y111----.""_ ..- Length of each line..ri[!' ... -- - .Width of trench.. Type of filter material, %Depth of filter material ��_-.. .._Total len th_. g 0?4?-------- ------ Seepage Pit: Distance to nearest well------- ............ .Distance from foundation_..__...--_---.---.Distance to nearest lot line.............. ". ❑ Number of pits................ ....Lining material-----------.--..._...-Size: Diameter.----... ----------- Depth...... - 1 Cesspool: Distance from nearest well_-_____---------Distance from foundation --------------- Lining material ElSizeriameter..... Depth... ............................ - ------_---_Liquid Capacity..................-.........gals. Privy: Distanceli'om ❑ .��,...,... Ag''"(zteSCn�eiaerest well.................. ••--•-•------.-.---r-• -.r. ....Distance from nearest b uildin g Di_ta—nce t— e •re�s lot line.................... t+ 16 r Remodeleai'i ''� `n ------ t ..... 7 - ------------------- ----------------------- ---------- -------------••-----I------------------------------- -----------------_ -------- tt I hereby certify that I have prepared this application and-that the work will be done in accordance with San Joaquin County $ ordinances, Stafe laws, and rules and regulations of the San Joaquin,"Local Health District. { (Signed)_.... s.. o'•"� ---— yf��J 8Y� ---------- - --....-------- - _ -'.�� te*mmm - (Title)- . (Piot plan, showing size of lot, location of system in tion to wells, buildings etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY... ................ ......................................... REVIEWED BY............ . .t............................. ---- ----------- DATE..-.-"--•-•----. ..__...........__....... BUILDING PERMIT ISSUED.... - ------------------•----- --------- �--- ------------- ---------..... DATE.-------------------- Alterations and/or recommendations: '.J------------------ ----"""--"-"""""'--•--••-••••••••••- __--t ' -• - -------------- ------------------••------..................•--_... ........... • .......•...._ ----------------••--.......... ........................................... 47 FINAL INSPECTION BY:.. Ir Date._ SAN JOAQUIN,LOCAL HEALTH DISTRICT 1601 1.Hazolton Ave. 300 West Oak Street s e 1 Z4 Sycamore Street I „} 205 West 9th street P Stackton,CaHfornia Lodi,California IF k. Manteca,California r Tracy,California F.P.E❑.