Laserfiche WebLink
FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT PonM No. <br /> ... . . _ _ .... IComplate re GrpRufa) js Date Issued ._.rPll .,6` <br /> This Perms m Esnires I Yew FroDate Issamed /"�„d <br /> _114-_eazon is kereby rrseda to the Ser Joeeldn Local Naal% District for a parer L•o construct end inrtal) the work hafain dwarbed. <br /> Tn,s application it made in compliance with an <br /> Cownty Ordinance No, 549, K''�7S <br /> '& a-/3.r 3 6 a .f.•�.' d f1_Y40-YO <br /> JOB ADQRESS �LOCATiONN .o w.� e�,r>w..a!f�j( 'k _ �'� - W Oanai s Noma. .IOIY'c '�. 'CCJJ - .,p ._ _. ._ Phw•e -. _ ..... <br /> Cunfrector's Nam. ...... . . <br /> -- <br /> It 40i!ee wi arvo: 'Residence (l"'Aose rwof House I]_ /Commartiel O Trailer Court ❑ Mato ❑ Otil ❑ <br /> Number of l',vkng ua s=ts: I Numboll bedroorrn 3/ Numl»r o the Lot <br /> water Supply: Public Sys” Q Community system C] Private �Qepfth eta• Table .. ..... It. <br /> Char"of sora to a depfk of 3 kat: Sand❑ C—arel [ j Soady Loom Cloy Loom Q Gey O Adobe 0 fierdoan <br /> Previous Application Made: Its yes.dote I No I] Noy+ Conttruc1_.p,: Yet [] No❑ FMA/VA: Yes -1 No 7 <br /> S- <br /> TYPE•OF INSTALLATION AND SPECIFICATIONS: <br /> • <br /> (No saptic'to rk or cesspool PernniMad if PW66C tearer is avaieMe wtNlit 200 Ebel.} <br /> jgptiC . k. 041ance {rens nearest wee $O r Distance from found4ti06 •'f 0! -� Meror:a! r . .._ ... _ . <br /> No, of compartmo,tt . 7 Sire.q'_l"X.yyJJV.L;wid depth. 1 ' capacity.&Poff, .. <br /> i Distance #Eons neerese wit .SQ' . .QfterKa {Tor. {atirdelion.�/a'r Distance to newt lot�inw� ... ... ep <br /> Number of liras... .. 3 Length o? each line. O WidrF, of .raftch <br /> Type of filter material. .�� Depth of filter mofer!o'_ f.ri N -Total a"th._ . <br /> Sset eye P,t D.stanca to "ergo well .. Distance from foundation .... ._.. Disfonco to naarost lot line . ... . . , t[ <br /> [] Number of pili Li-:iq material. .. .. Sita: Diametaf Deprh �`. <br /> . ar <br /> Ct4col: Distance from aeemil weli . Distance (fare fouadacon Lifting materiel _ .. <br /> (] S.xao Diameter..._. .. _ .Depth.. ..... ..._.. .... . _. Uquid Capacity. <br /> • t <br /> privy: D;stortce from noarasf woF.. . . ... Mows learn nearest building ) <br /> Q Distance to means loi ;;r,e <br /> ^ , ' <br /> Rarnodeling end/or-iepeirnq (dasniLro?: !'�._. "" .._. .. . .... .. - <br /> . .....__... .. ..,,. .- ... _........, . _, ......... _......._ . _........ . . ... _.. .... <br /> 1o1AFFy tkat I kw a Prepared lkis app9c yWa s oed Meat do work wX be dery in acoondonce W%San Joaquin County <br /> ord.nancp, Stall Iowa, eed rules and requlatiorn of Etre San Joaquin Local HesA District. <br /> IStgned) - -------- <br /> . .... . .. . _. . .. . . end/or Co sractml <br /> oy:-- -__ ._.... ........ . _. . . . .__ .. ..111461.. . <br /> IPW plan. sltowrrlq sme of lot kwatiorr f systwn on rabtion to -016. bullde19s, e1c., can be placed on reverse aide). <br /> FOR DEPARTMENT USE ONLY j <br /> APPLICATION ACCEPTED BY DATE ? /34�1' <br /> REVIFwED BY DATE <br /> BOLD!NG PERWI ISSUED. . .._ .. . .. .- DATE <br /> ANaraliens and/a' racornrrwndafions: _. . .. ... _. .. . <br /> //� __..............._.... ..�.J.__./........_._._...... .. __.. .. __ ..... .- <br /> FINAL WSPECTION BY: <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1401 a onskee aw. Dao ww oaa Hast 17 t sYr® "s•wae ids sues 1M V• <br /> 111100111010% taxi.eea.ra,rr McMata.[ariwmw Teary,GIJe.wa i <br /> as a".4w afa aw a•as rnaa <br />