Laserfiche WebLink
~� <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Comp��mo�u � Dmo�a�\ <br /> lete '—` Do+o Issued _�2��/��. <br /> . <br /> Application is <br /> onabv made to the San Joaquin Local Hoo|H` D�s+rict for n permit fo-6mu�uct and install the thnwoheroin described. <br /> T6 | d | with County {},d| - <br /> JOB ADDRESS AND LOCATION,------ )TV <br /> Owner <br /> s Name <br /> Contractor's Name--------------7�/V-7-4 4XV7--�----------------------------------------------------- --------------------------- Phone----------------------------------- <br /> Installation will serve: Residence &"'Apartment House E] Commercial E]T, Trailer Court E] Motel E] Other E] <br /> Number of living units: Number of bedrooms Number of baths -/--- Lot size0�P..��- .---------' <br /> � <br /> Water Supply: Public system P<ommuniify system [I Private F Depth to Water T6ble -7--le- ft- <br /> Character of on3 to a depth of dGravel El Sandy Loam El- Clay Loam El Clay F] Adobe 00'Hardpan El <br /> Previous Application Made: Yes E] No WRO� New Construction: Yes El No Pq-'-FHA/VA: Yes I-] No 2�— <br />- SPECIFICATIONS- <br /> (NoTYPE {]P �NDT�LL�T��N �N� ^ <br /> , . + <br /> septic tank or'cesspool permitted if public sewer ism°'iila6le 200 feet.) <br /> Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material ------------ ---- ' <br /> 0 No. of compartments---------------------------Siz^..---�-_ -------------��--Liqv;6 d=nf ---------------------------Capacity._---_ <br /> Disposal Field: Distance from nearesf-wO... .........Distance" fro 0 tion---- ------Distance to nearest t line <br /> Of <br /> ----------------- <br /> ' nvmoocxmg o°p/"r n°p*.n"e \"e^ "ue/...``,., ���wn���--..�~"w`. ._----._____--.__---' <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Cou�� <br /> in y- <br /> ordinances, State laws, a# rules and- reguItions of the San Joaquin Local Health District. <br /> (Signed) � ' <br />' Rv�- <br />. - .1�- <br /> (Plot plan, showing size of lo cation of system in relation to wells, buildings, etc., can be placed on.rever side).'--, <br /> FOR DEPARTMENT USE ONLY � <br />. --------------- <br /> APPLICATIONACCEPTED BY-'''_'-'''- <br /> xEv/Evvcu BY----------------------------------------- <br /> BUILDING PEK��|TISSUED'----__-. -_--',._-.�----__-1!---------------- DATE----.��------------------------------------------- <br /> Alterations and/or recommendations:---- ---------------------- --,__.-.------.-.--------_----.----____ <br /> A.3. 6-2.--..... 77?��..'..cp 4{..;I?�_-- -_--'...-.--_-.------_---__----_--____.. <br />� .-.__._----_.__----_-'---._---_--__-----^z-_.--..___'__-_-_____-___.__._. <br />� ---_----'-_'-'''--''---''''-''''-''----_''-''-'''--_''-''''--'''_----''''--'---'-'-'_-'-''_-.'-' <br /> �-''-''--'---_''---'-'''''_-.''-'---'-''-_''-^''-'---'''-_.'--''--'''--'--''''--'_-_----_--.' <br /> / <br /> -~��\ <br />/ RN/\L |�5PB�TON� BY:. -.-.. Dut,------~.~-' ^^----------.-._. <br /> »�SAN JOA/QU|NLOCAL HEALTH DISTRICT <br /> 130 South America" Street 300 West Oak Street f32 Sycamore Street owNorth 'C" Sfroe+ <br /> Stockton, California Lad% 000fo, ia . w°"te"° California Tracy, California <br /> ' ^ . <br /> ES-9-2wx°.is°w 1'57 F,pzo <br />