Laserfiche WebLink
OR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT Permit No. ..../..�'�l - <br /> (Complete in Puplicate) <br /> Date Issued .d1/..,;��f•-- <br /> This Permit Expires 1 Year From Date Issued <br /> t Application is horeby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is •-:acle in compliance with County Ordinance No. 549. ti/ r t5r�C_ r <br /> JOB ADDRESS AND LOCATION..��....�.1.nE..�cnr.E.,T.f�_)�c.i l.C...../122:c...... ....... F-6-U-1- <br /> Owner's Name. ................I�,.C'...........r:]j7.l.rx-'j.F :Fl.T E 1�.... .... _ _. Phone................................... <br /> .. ..... ..... . <br /> :.�:........ .........�'�:......... r.Iv. .r. ....... <br /> . <br /> Contractor's Name. ............. Phone................................... <br /> installation will serve: Residence ❑ Aportment House ❑ Commercial ❑ Traiier Covrt ❑ Motel Cl Other ❑ <br /> Number of living units: .. ,. . Number of bedrooms �­ Number of baths /... Lot size .....AC`.R E14.6.15•.. <br /> Water Supply: Publl; system ❑ Community sysiem ❑ Private C Depth to Water Table .7_0. ft. <br /> Character of soil to a depth -if 3 feet: Sand❑ Gravel❑ Sandy Loam❑ Clay loam (T�CIay❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes,dot-� ) No Z31" New Construction: Yes ❑ No [a"'FHA/VA: Yes j❑ No Ir� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted .f public sewer is available within 200 feet.) <br /> ' Sepiic T.ynk: D;%tance from hearts we _ll. Distance from founda!;on. .. ...... .. .Material ......... ......... <br /> No. of corr*nartrm,,nl, Size. ...... . ..... .... .. ..Liquid depth, (:opacity...._ E,r <br /> Dispesel Field: Distance From nearest well !?CI Distance from ,cundnt on^ �..U- . -Distance to nearest lot line.....,.... ..... <br /> T-I t46--' (dumber of lines / Length of each I:ne_. ��..`>r`... V`J al of trench .. �'...� _ .. <br /> E xLhr , <br /> + Type o: filter ma - l� .Depth of filter mato:!,:' eta! lergt <br /> ( Distance t nearest lot lire _. <br /> T <br /> Sa:'F,at;.• Pil• J:-.!ante to ne�:rasi wa!I Distance from founaa.�c:n ....... <br /> ' t o n <br /> Lia, Dc mate;ial.. Diameter <br /> Depth <br /> Cass r)5:•lr.C(s f,-o-n n••arc:.! well Distar.cc from fcund,rt .�n Lining material <br /> p= Liquid Capacity. .........gals. x <br /> Y from r.r.s•cs! well Da' :^cc from nearest building <br /> privy: ";,IanCG ... <br /> J D'c+,ince !„ era•.: t I`r't __ <br /> I heroby certify that I hive- prepared this application and chat the work will be done in accordance w;$ San Joaquin County <br /> ord:ranccs(,Statn laws• and hales and regulations of the San Joaquin Local Hcaith Dktrict. <br /> I (Omer and/or Contractor) <br /> (Signed) .i�` C• / i<< '��C :f! .•C. J _ <br /> (Title) <br /> (Plot plan, showing size of lot, location of sys}em in relation to wells, buildings, ate., cin be placed on reverse side). <br /> FOR DEPARTMENT USE ONL.' <br /> I . I '• DATE <br /> DATE <br /> DATE <br /> F,.. ii, l` <br /> Alterations and/or recommc•ndaticns: <br /> , <br /> SAN JOAQUIN LOCAL HEALTH DI"TRICT„ <br /> '10;w„•c<,�s,.,.... 174: zo,w.,+v/M <br /> 1601 E Karrtron A.•. ” <br /> i tin,�,u n,Cor•+u•�.o <br /> �. Cu .,•,.o ,.��... Luer Cuh1c,::•o <br />