Laserfiche WebLink
\ �� � 7 <br /> 66 \ \ � <br /> � APPLICATION FOR SANITATION PERMIT Permit No. <br /> hm OmpU�mfo - <br /> (Complete Duplicate) Date |,,ue6 --- <br /> Application <br /> is hereby made to the San Joaquin Local Health District for o permit toconstruct and install the work herein described. <br /> This application ismade incompliance with County Ordinance No. 549. <br /> JOB ADDRESS /\ _J����u��<­A____— <br /> ' N ------------- Phone--------------------------------- <br /> - --__ '-- - '------- ------ -----------------------------------.. .-_.-_-_-_ <br /> 7 <br /> Contractor's Nome--- -_--_---_-- --------------------------------------------------------------- Phone----------------------------------- <br /> Installation will serve: Residence Apartment House [] Commercial E] Trailer Court | [-] Othe <br /> Number ofliving units -/-' Number ofbedrooms Number ofbaths -|----- Lot size .12 -] -..Y .��� --- <br /> 4�---------- <br /> ----------- <br /> Wafer Supply: Public system El Community system [I Priva Depth +vWafer Table -------- ff. / 05 / <br /> Character of soil toa depth of feet: Sand E] Gravel ElSandy Loam � C|uy�� El Clay � Hardpan El <br /> Previous Application k4a6m: Yes [] No jj� New Construction: Ye, X No F] FH4/VA. Yes 0 NoX <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (N* septic tank *r'coopoo| permitted R public sewer is || b| within 200 feet.) <br /> R4 <br /> ^- � ! ---- <br /> Septic Tank: Distance from nearest we||� � -'D| o from foun6o+ion_ - lj --� ��+o,iuL. 4^-KNo. ofcompartments-.. -.. -----Liquid 6P+h-..u2---.-- apocif^ <br /> Di,pnsal Field: Distance from nearest U � � Disfance from foundation / 6 line <br /> Ul�� to �«+ | |�� `�� ` <br /> �� Number of | - <br /> ' Type of filter material- �8�eptk of filter mu+e6L <br /> � ,/J�- _-T <br /> �. o+ul length-----i�]���_ __-- <br /> �� <br /> Seepage Pit: Distance to nearestwe|�'--l-----------Distance from foundation--------------------Distance to nomnat |c* line''-'--- <br /> El Number of pits----------------------Un�ng material----------------------- Diameter.--.----Depth------ ------ ------- <br /> Cesspoo : Distance from nearest well Distance from foundation Lining mo+eho| <br /> Privy: Distance from nearest well ---------------'Diotonco from nearest building-------------_-- <br /> Distnnce +nnooms+ |v+ line----------------------------------------------------------------------- ----------------------------------------_______� <br /> � Qomo6eling and <br /> r n:poi,ing )�--- -- ._-_--------------------------------------------- <br /> --------------------___---------___-----__-----------__-----__------'__------_�-----__------_�-­----_--------_----------'____-----------_-----__---------__---__�����- _ <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> I hereby certify the+ I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, SAate laws, and rules and regulations of the San Joaquin Local Health District. <br /> F'/9 --_----_-------_--.—.(Ownorand/n, Cnntractwr) A, <br /> '-_--.'-_'''-'''_'--.'''_--'''''-'-''--'-'-_'-_.'--'------_- -, ''---''-__--'-''-''-'-''-- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> ---------------------------------------------------------------------- ------------------------------------------------ ------------------------------------------------------------------------------- ------------------- <br /> ------------------------''-''''-''''''_-''''-''--'--'--''''-_''--'--''' ---------------------------- .'__----.'- <br /> ------------------------------ ----_--._--'_-._--.__-'-_------._---------._----- <br /> �� <br /> FINAL INSPECTION BY:---.-1,��_.�� --------------------- Date----.L�'-�..4n��----.�...��--.-- __---� <br /> SAN JOAQU|NLOCAL HEALTH DISTRICT <br /> /so south American Street sooWest Oak Street /sz yr"°mvre Street ow North ''C^ s*~m <br />\ <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ex--p-uwm°"u°a /'orr.P.co. <br />