Laserfiche WebLink
� <br />APPLICATION FOR SANITATION PERMIT Permit No. <br />(Comop|efe7nDuplto// <br />�*'1 <br />Date |x,ue6 -.'.lLa/�� <br />.� /__.. <br />'Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br />This application is made in compliance with County Or ance No. 549.JOB ADDRESS AND LOCATION— <br />. _''' <br />.-__--°~—^�-�� ^ <br />_-_--_----_--. <br />Contractor's Name - <br />' - ---------------------- <br />Installation wil <br />_'''|nsta|lafionwNsemo: Residnnm�po����H��n:[� Cumne��| T�i| ��r�[] � | <br />.... [] <br />. <br />Number of living units: J- Number of bedrooms - �� Number <br />' <br />Water Supply. Public ,yohxm XCommunity oyoh,m [_-] Private [ Depth +o Water To�o3sft <br />' ----'--'--'' <br />Character of soil to a depth of feet: Sand E] Gn,vo| [] Sandy Loam E] [1oy Loam [] Clay [] Adobe Hardpan E] <br />Pr*v|nmo Application Made: Yes Ll No g New Construction: Yes.K No E] FHA/VA. Yes F� No [] ' <br />TYPE OFINSTALLATION AND SPECIFICATIONS: <br />(N* septic tank mrcesspool permitted if public is availablewithin 200 feet.) <br />Septic Tank: Distance from noures+ we|L3­'S---- <br />�Distance <br />from <br />;«�` � | <br />C � ----- <br />Nn. ofcompur+mont, ��� 4{ <br />��___..�i;e.�';-'y,-_Liqui6dp7� <br />; Distance from nearest wrU----------------- Distance from foundation -------------------- Distance fonearest lot line � ._'' <br />Number of lines ----------------------------------- Length cf;o�� line ------------------------­---- of <br />Type of filter moterioL-'------Depfk of 'filter material ------------------ length ----_----__---- <br />Seopnge Pit: Distance to nearest weL-_-_--------- Distance from foundation -------------------- Distance to nearest lot line - �� <br />0Number of pits ---.---_Lining materiuL__--.-�S|ze: Diumut6c----_—Dept ----'----_ ~~� <br />�u�oc <br />Cesspool: O�t,no, �pm neure�weU-._-_--Di�unon�omfound^�on----'--Uning material � <br />[] S�r,L�ome+ec..---'-',�--'--Depth -.---'-_--------'--.�ouk] �y'__--.—.-'o|� - <br />Privy: Distance from no*ras well ------ ------------------------------ Distance from nearest building ----------------------------------- KA <br />___ ---------------------------------------------------------- <br />that the work will be done in accordance with San Joaquin �mvvfv <br />,aquin LpcaDistrict.Haa|�hDistrict.' ' <br />==_--------------- ----- ------------------ `.to wells, buildings, etc., can be <br />... <br />FOR DEPARTMENT USE ONLY <br />d/or Contractor) <br />APPLICATION ACCEPTED BY ------------------ --_-'-_-_-_-.__ DATE-- � <br />REVIEWED RY' /^-/ u~-��`�-~''--'----- <br />-._---_------�,c-�.-_-_-----.-�_--__-__._.D�TE_-._--.__.- <br />BU|LD|NG PERMIT ISSUED ------------------------------------------------------------ _.'-'''''--'''_-.' DATE'-'''__.-_. ---'--'--''--- <br />Alterations and/or ,acommen6w|ions: -------- ---- ------.___.------_---_--.-.--_-------------_---____---' <br />--' <br />_--_-'--'''----.'--'--_-''--..-''--''''-'''--''---'-------''-_''-----'''-'''--_-'----''_-.-_---__ <br />--__----------________--_���__�____��'�����____�____�____��___�___���__�___� <br />-'''-'''---''''---�--'-'--'_-- <br />. y . <br />'^ RN/\L INSPECTION BY: ------------ ---------- Dute--\_..\.��.-~�*~�--_-------_-' <br />SAN JOAQ0NLOCAL HEALTH DISTRICT <br />130 s""m American Street 300 West Oak Street oz Sycamore Street ww w"*h "C" Street <br />Stockton, California Lod;, California Manteca, California Tracy, California <br />sS-9-2M' Re°is°w 1'57 F.poz <br />