Laserfiche WebLink
1-URoFFICEUSE -`~~~ <br /> . <br /> ----------------------------------------- <br /> Joaquin Local Health Dist rict for a permit to construct and install to work herein descrUid. <br /> � This hereby made - the San <br /> TION_application is made in compliance with County Ordinance No. 549. <br /> ` � <br />. � <br />| � -----'---------- ------------'--_'-_. Phone............. <br />) <br /> Installation will servo.- Residence �� A��� H�� � Commercial F] Trailer Court E] Motel [] Other C] <br /> of living units: 1. ' Number ofbedrooms �� - Number of baths � .. Lot size ........ .4r .� ...............-------------- <br /> Water Supply: Public system N Community system [] Private D Depth to Water Table _-- ft. <br />\ <br /> Character ofsoil tomdepth of 3 feet: Sand E] Gravel F] Sandy LoamZ Clay Loam [�y � �o�[] H���nC1 <br /> Previous Application Made: (If yeo'6oto-------------------- NpBd New Construction- Yw, �o No E] FHA/VA. Yes [] No (] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ' <br />| \m6wwp+ic +mnk mroeuopoc| �mrmnR+;d irpu&Kc-sewerlwm°aUable within 200'feetJ'm~- -'-�- - - ----- ~-~-~~ ' ----� <br /> Septic Tank- Distance from neumx+ <br /> -�'_-�Distance`-;_'-_--_�--'--'-_-..'-_-_-.---.D--l~�o-�n- <br /> _-JPt---�~. <br /> Material-A-4 <br /> hy |uL <br /> ._-'-_-'---` <br /> No. of oompurtmunt�./ � - -- Liquid de�h- / -----.0-, `_-- <br /> --_J_-�'-/---, <br /> '..- <br /> -_-_-_-_ <br /> Disposal Field: Distance from well2J7A �° <br /> Type of filter material <br /> III <br /> tal <br /> Number of |� Depth - ...Tolength <br /> �'-- ---'----'-'Seepage Pit: Distance to ra� ~� 0�� _Num6o, ofp�s..'��__-Un�g Diomoto,-33O .. <br /> Cesspool. D��nca6omnoun�twei_.----D|�ancefnzm'fnun6uMon---.-.--Uningmmtw,�L--__'-_---- <br /> [ Size: Diameter _---.__----Deof�..-��--_-_--'_--_..L�ui6 Cap. ��---.-------gm|� <br /> Pd,y� D| uncw {n�m nearest w�|i'''_-'''----''-'''-''D�+wnc= from nooro� b�� ng--'_-.-__-- <br /> LJ Distance to noune� lot |�o.---'_-._.. --_-..__'__.'--_._-----_--..-_.--.---------_-'� <br /> Remo6oing and/or repairing (6ez�6e):---.___--_--_.�-_--'.__-__-.--.-__-_----__ <br /> _-'----.___._--..______.--'__---_--__.__--_-_-__--__.-___..__-_--- '---.-_.-.-_--' <br /> .-_'-'--_-.'''-'--__-''--''__.__-___-__.-__-_''-_.'__.___--_'-'-''-'- .-__----''-_--.. <br /> -----__--______----_..-_----__--_-___.-------____.._-..__.__.-'----.._ _--__-- <br /> certifyI hereby <br /> ill <br /> prepared application and - the -- ' be ' accordance with °=" Joaquin C"""'vord�ance» �fmf� <br /> (Signed) <br /> ° <br /> ~ <br /> ' <br /> ....i. <br /> ner and/or Contractor) <br /> ------------------- <br /> --------- <br /> Y:::7=.= - . se s_ <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION AC CEPTEDBY. _.--------_'----'- <br /> REVIEWED B\ --_-._-_-.-_ _ DATE <br /> BUILDING PERMIT ISSUED - ---_-' - ----'--- <br /> -.--_- Df7E----'- <br /> AMe'mt�nuwnd/wr ,ncommmndat�nw� __----_-----_-._---.__-.-_..-__.__-- <br /> '_-'-----' --_-``-------'' - _-'--'--'' -'--'--_.-_.-'-' <br /> ---'---'--''-'' --'----'---'---'-------y ___.__ <br /> -----'--------'---- _-..�_________ <br /> ('-''-��-'''-'' -----' -''-'--'---'_''-'''-_---- --'-'-''-'-' ---''-.--''-'-- <br /> HNXL INSPECTION BY _________ __.________.___. <br /> SA4 UN LOCAL HEALTH DISTRICT <br /> . , <br />� 130 South American Street 300 West Oak Street _ 124 Syc°tno=Street <br /> 205 West 91h Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California � <br /> = v vx°°m "'°9 "u "'°. ",u° ' <br /> / - <br /> ��� � <br />