Laserfiche WebLink
/ y <br /> APPLICATION FOR SANITATION PERMIT ' <br /> (Complete <br /> _ - <br /> A��|oofon i, korobv made to the San Joaquin Local Health District � o permto construct um� install the work 6em� � <br /> n � c�6d <br /> T�|� application 'is made incompliance with County Ordinance No. 549. ~ <br /> or <br /> ------------------- Phone------��"^"'�'��'�~-- ' <br /> �66 -- | <br /> � Phone .J~�� / <br /> Cqn�acto�x Name----------- .—___—_—_—�-----.--�_^--__—._.. —^—_~-. -- <br /> | ' �� ��e Residence �� Apartment [� Commercial [] Trailer Court [� k��� [] D+�r [� ^ <br /> noaxmmmn ; , � " �v1 �� / 2 »+ , <br /> Number of living unit`' Tj Number of bedrooms [*~ Number of 6otko [M Lot ,�v-'_���r--'xf—'~�-����--_--_' <br /> Water Supply: Public system tK Community system 171 Private <br /> Character of ,�� � a �eo—� �� ��� Sand [� G�`� �� Sandy Loam E] Clay Loam [� Clay E] /�obe�0 H���n �] ' <br /> " , --. � <br /> TYPE OFINSTALLATION AND SPECIFICATIONS: � ~ <br /> (No septic tank or cesspool permitted if public sewer isavailable within 200 ' <br /> .. depth <br /> ' -nk� Dix+�noa from no ---Se, � � <br /> No. of cumpo�mv��___ -------------- <br /> Cesspool: <br /> .*� . <br /> .. opac|h'..� -_.S�e__.—._�___L�uk] 6eot�-_..����_-_ <br /> Ces poo|: D|stonce from nearest well -_�---_Distance from foundation--------------------Lining material------------------------------------- <br /> Size: <br /> --_--_--_-- <br /> Size: Diameter_-.___.----'- -----Dept h--._--.—__----__�__.- <br /> Distance from nearest well------------------------------------------------- from nearest build i _------._—._- <br /> Distance to nearest |o+ U <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------rDisfance to nearest lot line-------------- <br /> F-1 Number of pits-----------------------Lining material-----------------------Si7e: Diam;fer------------------------Depth--------------------------------- <br /> es <br /> Dispe,eld: Distance from nearest well--Z-, ---------Distance from foundafic ----------Distance to near t) t <br /> filteType cnfilter "a'°"'m��^��+�-�'~°~~r^' ~' -- -------'----'-- <br />. <br /> Remodelingand/or repairing (describe)' ---'----/ <br /> 1 t <br /> ` <br /> hirebm+ the workwill be done in accordance with Son Joaquin County <br />\ o,6/' ,mw. 'State certify laws, and rules <br /> 'and regv|a�nmsrepared this �nfthe San Joaquin Local Health District. <br />^ ^ <br />^ ' <br />. (Sig.e"+_. ' . . <br /> Bv�_. ----''--------------'------------'---(T��L-------------'---'--- � <br /> ��f plans,' showing size of lot, location of system inrelation fowells, buildings, efc.. must be filed with this m / <br /> FOR DEPARTMENT USE ONLY <br /> DATEAPPLICATION ACCEPTED BY-------------------------------------------------------------------------------------------------- --.___---__._-----__' <br /> DATEREVIEWED 8Y_.—__..__—_—_—_'----_—_..__-------_--__�_----_- _—_—__—.__________. <br /> ------------------ <br /> --------------------------------------------------------------------------------------------------------------- <br /> �4P 'I 1�00 N BY:------------------------------- - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT % <br /> 130 South American Street <br /> Stockton, California <br /> B-9-2w 9-50 W-1639 ~ <br /> �' � <br />