Laserfiche WebLink
� <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) <br /> Date Issued <br /> ication is lichonabv mo6= to the Sun Joaquin Local Health Dist ricffor u permit to construct and install the work horo.Jin?�6o^described..�6-o�6�. <br /> pii <br /> Tapplication <br /> is made in compliance with County Ordinance NO'. 549:- <br /> JO8ADDRESS AND LOCATION-----------------------1�- ------------------------- ._-----------------------------------------------------------------------------------------_-- <br /> Ownor's Name---------------------------- ----1,_Q eq--------------------------------- -'---=--'._--'~_Phona.-'�f^��'�4�-.-_. <br /> AJ6rmz____-__..________._--__-.s-ftrvig�- '-__.___.�,_'__.._.__._-.___.---___-____-__-_.' <br /> Co"�acto�, Name------------------- ' Phone ......... / <br /> -___--___-__--.-.-~~'�^-._.--__---_-___'-_----.-- ___ _' ` <br /> Installation will serve: Residence U Apartment Mouse F1 Commercial [] Trailer Court L] Mofel E] Other' El <br /> Number ofliving units: '�--- Number cfbedrooms ANumber of 6mH,u _,__1--- Lnf ,izv -_ /� ��' �`- / .�' r�..__ <br /> Wafe, Supply: Public system % Community system <br /> ' El Private [1 Depth to Water Table -------- ft ' <br /> Character of soil to m depth of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Lo�m [] C|oy [] �6n6e�� Hardpan [] ` <br /> Previous Application Made: Yo, E] No New Construction: Yes F-l No E] <br /> TYPE OF INSTALLATION /\ND'5PEC|F|CAT|{}NS; ` <br /> (No ,op6o tank or cesspool-pormifto6 if po6|Yc sewer is uvmUab|o wifh|n 200 feet.) <br /> Septic Tank: Distance from || ]CQ i-0-f <br /> N_ of compartments_ - _'~ ~ '- - - ~` Liquid depth .- ~,'..., ~ <br /> D� | �p|� �� ��� ��� in -j@�11 k <br /> Soupoge Pit: Distance to nearest well-'------------------Disfunce from foundation-------------------Distoncnfo noon,,t lot line----------------- «�m� - <br /> F] Number of pits---------------------- material----------------------- Diamvtoc.-----_-Dupfh-_---------.- - -~ <br /> Cesspool: � Distance from nearest well-----------------Distance frnm foundation------ -------------Lining muforiaL''''-''�_-�--_- r~' <br /> v ~-"�� `~^ <br /> E] Diameter----------- Capacity--.__-.�---.-'gals. <br /> ~ <br /> _ . Pr|vy�`*=_�~ ���.����n��'f,�� n�o,uy+ vm|[��---����---����.�.��������-.Di^+o�cv �r*��' �o���t 6ui|�in g-.--------.---,---- <br /> El Distance to nearest lot kno-------.-'_----__-.-_.___-.__-----�-__�-__-_____ ~~~' <br /> - <br /> Rumodoing and/or repairing (doscr�be)c= =�----__-_-_-- --- <br /> � --_-___---'-'_--__-'_'_'------.-''_-_-''-__'--'___'''---'-' <br /> ������­'------ -----------------------'-------------------­­--------_------------------------------------------------------_---------------'--- <br /> --------------------------'��---------------'----- <br /> '-----_.'__'''--''___''''___'''_-.-_.'_-_.'-_.__'---_--'-__'''''--'__.'''__'-_.-__-''-'_---'''-- <br /> | h�� ' ���^ �� �� have red this application the work will bedone inaccordance with San Joaquin County <br /> ordinances, State laws, and Joaquin-Local HouK6 District. � <br /> ` <br /> (Signed) -------------------------------------------------------------------------------------------------------------- anJ/o, Contractor) <br /> By:--------------------------------------------------------------------------------------------------------------------------- -------- -l-'-___-----_--_--.---.-- <br /> (Plot xlan, showing size of lot, location of system in relation to wells, build|n gs, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> 'APPLICATION ACCEPTED -Y-------------------------------- <br /> ------'---------'' -A'--- -��'��----'' <br /> ------------- <br /> REVIEWED BY------------------------------------------------------------------------------------------------------------ <br /> -6 DATE-------�[.^-------'---- ---_________ _ <br /> 8U|LD|NG PERMIT ISSUED------------------------------------------------------------------------------------------------------- DATE-----------------�^._.��-------------- <br /> Alterations <br /> -_�,.��-__ <br /> Alte, +ionsmnJ/or ,ocommwn6wtions:__-__-----'_-__.___---..___._-__-_-_----_-___.-___.-_- <br /> ---'--''---'''--''--'''''--''--''''''-''-'-''''-'-------'' '' <br /> _______________________�__________________________________ __ <br /> -----'''--'------------------'--�-�--�-------'-^ ~�''---- -- -~-'-/'—' <br /> -------- <br /> -------------- -'_`-''---'---''''-_'----''''-''--'^'--_-----'''-'-_---_-'-'--''''----''`'''_-.'''_-.-_'- <br /> FINAL INSPECTION BY: .r�� �~ Dv�-------------- <br /> . ---. —..�___-,__-_-._ <br /> SAN JOAQU|NLOCAL HEALTH DISTRICT <br /> oo South American strwt smWest Oak Street /sx Sycamore Streeuw North "C" Street <br /> Stockton. CaliforniaalodCaliforniai;*,nLodi. California w^"o,*^. California » <br /> }* "" Uo| ' ia <br /> ' <br /> ES-9-2M 8-5/ Revised *v-2/00 <br /> `. <br />