7130 - Laserfiche WebLink

Home Browse Search

r —7 ` APPLICATION FOk.._ANITATION PERMIT Permit No. ."".7!_ ___ (Complete in Duplicate) .' Date IssuedSw-- Applica+-ion is hereby made to the San Joaquin Local Health District for permit to construct and install the,work herein described. This application is made in compliance with County Ordinance N•o. 549. r ! 1 i JOB ADDRESS AND LOCATION""".__""""-_- __232 S. Golden Gate : - - ----------•---------------•--•------------•------------------=---------------------------------- ----------- M�r CO Macho Name---------------`•--�-•------ma.Cho ---------•----------- -----------••---------------- a5 P one--- ----------------- 92 A dress ---------- -----------------!9A - Contractor's Name--------------Dei•t"a E Phone------�'!x 9b9- Number se vunits: 1 ® p ---------------------------------------------------------❑ mrcil ❑ --------------------------------t ❑ ❑ ❑ Installation will serve: Residence Apartment House Commercial Trader Court Motel Other living _1-__ Number of bedrooms "�--__ Number of baths -_-.--_ Lot size .""_ d__x"-� 0 I $ S ------------------------------- Water Supply: Public system g] Community system ❑ Private [:]; Depthfto"Water Table F Character of soil to a depth of 3 feet: fSand ❑ Gravel ❑ Sandy Loam❑ Clay Loam ❑ Clay ❑ Adobe [ Hardpan ❑ Previous Application Made: Yes ❑ No:] New Construction: Yes ® No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: { - t I �(No septic tank or cesspool permitted if public sewer is available within 200 feet.).. F Septic Tank: Distance from nearest well-----------------Distance from foundation__'_-_--_:.--- -w_.Material---:-".""","._"""---_"--_.."".__""-_"""- rx�Sting No. of compartmeni-s--------------------- ----Size----••------ Liquid depth t - Capacity ------------------- Disposal Field: Distance from nearest well------------------Distance from`'fo'undation................. --_-Distance to nearest lot line_________________ e�Sting Number of fines------`--------- t Length of each line---, Width of trench ----------------- Type of filter material----------------- .,E' i Depth of filter material--------------.--___---Total length---•---•-----•-----•---------- ---------- Seepage Pit: Distance to nearest well--_----aQ------ __Distance from foundaiion__- to nearest lot line_-__5� Number of pits-----Z- -------------Lining material__ br1Cs-----� til , I - - - - -- Size: Diameter-----�---------------Depth------ -�>�rs� _�_�_ Cesspool: Distance from nearest well-----------------Distance from foundation----------._k. ---.Lining material--._:----_-_-_-_ ❑�. Y ,•_... Size: Diameter:n-tt-------------------- ----------Depth-------------- • , ----------- ----Liquid CapacitY- -------------------------gals. Priv Distance from nearest well__ ______________________ _Distance from nearest building.- -- ; �., Distance to nearest lot line.______ _ _ - "�" - -----------------------------------•- --------------------------- -----•----- ------------ Remodeling and/or.repairing (describe):-__--_-____--_-_ s acl ° e i s i"iii sept S S, }� ------------ i ---------•---------------- 1 ------ ------------------------••-------------------------•------------------ ------------------•-•--------•-------------------------------------...---------- •----------- ---- 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. (Signed)--- ---------------D'?t ------------- l ------------------------------------------------------------------------- --- B Per , Warth -"""---[Owner and/or Contractor) Y� -=- ••---- Vin= _ (Title),,,,,, ,.., .. . le) taA M€, rt (Plot plan, showing size of lot;location of system in relation to wells, buildings,efc.., can be placed on reverse-side' everse side s .. . [ E FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ~_"-___-!._____-_______ -_- ------ ------ DATE?"...e ---------------------------------------------------- REVIEWEb BY f� ----------------------------------------------------------- ------- DATE BUILDING PERMIT ISSUED----------------J----- -------------•-----------*---------- DATE -•---------• ------------------------------------ --------------Alterations and/or recommendations:__.."""_ ,r ------------ --••--------------------•------ --------------- --------!::5 •_------ ---------------- ----------- } _ ----------- ------t ' ---- -- - f r FINAL-INSPECTION' BY Date------- ------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street � 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M ; Revised W-2100