Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT Permit No. <br /> . <br /> (Complete in Duplicate) Date |ouo6 <br /> � <br /> Applicatio''n is hereby made to the San Joaquin,Local Health Dist rict for a permit to construct and install the wor�*rein <br /> described. <br /> This application is made in compliance with County OrdiAnce No. 549. <br /> , <br /> - --r's Name-------------------- . <br /> |nstallation will serve: Reside n r� <br /> -/-! ���s� House � �.Commercial <br /> � Trailer/ C� MotelMotel..�C]D�t�OtherOtherNumber of living units: ' iNm6orofbedrooms _11.'yum Lot size <br /> � h�ommunity system [ Pvu+ � � +nVoforTable'-'-3- f+.Water Supply: Public system Em � <br /> Character-of o*U to a depth of feet: Sand [] Gravel Sandy Loam E] Clay Loom [j Clay 0 Adobe 11~4,rdpon [] <br /> . ' <br /> Previous Application Made: Yes E No Ef~~New Construction: Ye, pc�~�� [� <br /> TYPE OF'INSTALLATION AND SPEC|F|C/\TIONS: <br /> /N' septic tank or cesspool permitted if public sewer is avmUm6|o within 200 feet.) <br /> Di I Field. Distance from nearestwpll---- from foundation fance to nearest lot line----------------- <br /> ~~^~r``': Distance-- from nearest well-----------------Distance from foundation ' <br /> Liquid C | <br /> ��� ��- -- -- Distance from nearest woU---.-__---------.Distance from nearest' ui <br /> [� <br /> ----- --- <br /> ' Distance +o ne�pa,f |o+ |� ' ___--`,__--__'__-____________--- ^`^ <br /> � <br /> ~ . n � -------------------------------- <br /> -- <br /> �� �c �,� ..Romod |i and/or '� (6nm:�b� r � .� <br /> ~ ._-----__---_._---__'--_.—'-'-__-----_._----` ''-'--_.-'''-'-�-''— <br /> - <br /> � __..-- <br /> ___- ._-'-''-___.---___--._'--'-_-'''--''-'�-'-'- <br /> -----^~-~~-~...~---. --_---.__-_----_-___--___--_---._--- <br /> | hthat | h*vwpre p1|c*fionwn6 that the work will be done in accordance with San Joaquin County <br /> ordinances, State |a*o, and rules an regu|mflnno mfthe San Joaquin Local Health District. � <br /> (Signed) ----_---------.. and/or <br /> ~r -~~''~-*n�~°^ ---------------'---`'--,------'-''-''-'-----'-- <br /> (Plot plan'l showi size of lot, location of system in relation to wells, buildings. efc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY DATE_ <br /> REVIEWED BY----------------------------------------- ------- ux/E "� <br /> BUILDING PERMIT ISSUED -----__—. DAT�--'�----..- -._-' <br /> Alto,aGvrio and/or recommendations---------------------------------------------- ----------------- <br /> _-__---____-_---._------.-_--------.--._-_---_-_-___-------__-_-----.--' <br /> '_-'---�-'''-''''-'---'''''''-'''-''''—_'�''-_''''---'''—'--'�'-''-'-'''-__''-''_--'_'--__._-.-- <br /> '''''_-''_'''-'�'''_--'-''-'--'-''-- <br /> ' <br /> ---- <br /> FINAL :INSPECTION GY�''—_--'^��'��'���'' Dute----�'�--��'-~~�'��--'''-'------- <br /> SANJOAJU|NLOCALHEA[THDISTRICT <br /> /soS""m American Street 300 West Oak s*="* mo sv""m"re Street m* North ^o^ Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> � <br /> ES-9-2w 10-52 xo~/,°6 vv-2/00 <br />