Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT <br /> (Complete in inDu9|(cate) <br /> Application is hereby na6o to the San Joaquin Local Health <br /> District for <br /> u permit +qconstruct and install the work herein described. <br /> This is made incompliance with County 0'� ncNo Y ~ ~ <br /> ' <br /> 7 -. L - - -------------------------------------------------------------- Phone------- ------------- <br /> -------------------------------------- <br /> Address----------------------------------- �� ~ <br /> 3 '? <br /> - <br /> ) <br /> Contractor's Name------------ p�on- . - � <br /> -------- <br /> Installationwill serve ResidenceApartment House Commercial [] Trailer Court [] Motel 0 Other [ <br /> Number of living units: Number of bedrooms 21 Number of 6a+h, U Lot a|oo ' r-~1~'~--''--'-----' <br /> ' <br /> Water <br /> ��� Public system � Community �� � p�� � � <br /> Character of soil to a depth of'3 feet: Sand 0 Gravel 0 Sandy Loam El Clay Loam F] Clay 0 Adobe IV Hardpan <br /> TYPE OFINSTALLATION AND SPECIFICATIONS: <br /> `No septic tank or cesspool permitted R public sewer is available within 200 feet.) <br /> Septic Tank; Distance from nearest well------------------Distance from foundation `� <br /> - te iu| /m <br /> �� ur --'uqu/o oop"._'� _--_.- <br /> '- <br /> No. of compartments �__-_-CopaSize-= ' -- <br /> { pool: Distance from rest well Distance from foundation- ^ Lining� maferi | <br /> [] <br /> � <br /> &4w Diameter Depth <br /> PHvy: Distance from nearest well Distance .... nearest building------------------------------------------ <br /> Distance to <br /> -------------Distann: +o nearestlot line <br /> ' Soepoge Pit: Distance to nearest well----------------------Distance from foundation-------------------Distance .° .~...~ .~ line--- <br /> Number of ' ---'1 ----Unlng m*te�uL_-____-�z�� Diumefec__-__-_-Dopt6__---__---- <br /> . � - �- � <br /> D�pu�| ��d' Distance nem�af / U-----_--Di�oncnfmm foun�o+�n-. CUdancofonean�t �f |�"-� ... <br /> .__ <br /> ' ^ <br /> ���'�� � ------------------ <br /> Type <br /> Number of |i of each line V �f� of �enc � <br /> ______ <br /> Tvpe <br /> of filter materiuL�. euf of filter m�ter�oL.-��n���'_ , <br /> , ^ <br /> Remodeling and/or repairing (describe):------------------------------------------------------ ____ <br /> ._________'____.-_____._____.---__-__--'--.---____.___--..__.�___-._-__-..__-____-._� <br /> '----'---------''--'----'------''------'''---'-----'-----''--''-----''---'---------'------' <br /> �������``����`��``��``��`��������`���`��������`�`�����```��`��'`������'� <br /> ---'-�-------'--'''�ef | � ' � this application and that the work will be done in accordance *�h San Joaquin County <br /> \ �� mpp"�mn <br /> ordinances, State laws,3 1 d re ulations of San Joaquin Local Health District. <br /> ' <br /> (Signed) ` - __.-. He1---_-----'----------- <br /> my: ------------------'-,--'-----'----'-'---------' ` ' <br /> (Rot plans, showing size of lot, location of system in relation towells, 6u86ings, otc., must be filed with this application). _ <br /> FOR DEPARTMENT USE ONLY ' <br /> '`' ' L'~'`'—' ' ---T-- - ------------------------ --------------------------------------------------- <br /> DATE ~^ / ��Z� ^ `� ^- <br /> REY|EV�B} BY------------------------------------------------------------------------------------- ______��// .__, _______. <br /> DATE . <br /> NG' PERMIT ISSUED_- ' <br /> Alterations and/or recommendations:----------(--I- ---------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> |30South American Street <br /> Stockton, California <br /> ES--9-2M 9-50 W--1639 <br />