Laserfiche WebLink
, <br />� <br /> =' -^~^ 0�PPLICATION ~F_O <br /> R SANUTAJUON PERMIT Permit No. <br />} ��m�m� � C�;��f� Dm+o |*oumd <br />- --------------------------------------------------------- <br /> (Complete --'7-_-`---' <br /> Application is henv6v made to the San Joaquin Local Health District for u permit to construct and install the work herein described. <br />\ <br /> This application is made in compliance with County Ordinance N <br /> 1 �~� <br /> JOB ADDRESS ANP�LOCI ION..........!7iO------ --- ..........fla .......................... ....... <br /> ' <br /> Installation will Resid """=^'=''��-Trailer" ~~~'' �� --- <br /> i ED Other 0 <br /> Number of living units: __/ Number of bedrooms P?--- Nu�irlber of bath, .4 Lot size --------......... <br /> Water Supply: Public' system` _ ^~ ' . . . -- , -- � . ~�� <br /> C��� � � � a �� �3f� S� � �,� � '� El (� �m � [� 0 Adobe~`� n�clpanC] <br /> Previous Application Made; (If yes,6ote- --------- -') No [] New Construction-. Yes [] NoQ~"' . Ymy [] No <br /> ^ <br /> r TYPE OF INSTALLATION AND SP��|HCA?kONS: 1 � <br /> � ( 0 septic tank or cesspool . /,mit+w6 if public sewer is mvaikm6leWIThn 200 feet.) Y <br /> ' ~ � <br /> � <br /> Distance from nearest well .----'Distance from foundation--------------------Material --,--_--.----.-,.r..- <br /> -- <br /> No. of compartments--------------------------Size-------_----------------------LiquiddeRth <br /> Disposal Field: Distance from nearest wel')Lf.W_ ..Distance from foundation- ----------Distance to neare <br /> Number,of lines-!------ Length of)each line-.--- rr.....Width of <br /> Type oUfilter ma�terial..�t-_R Depth of fi --mate --------- <br /> | ^ <br /> � <br /> Seepage r' "."".ce ." '=""=' ~'^ <br /> t m f ation----- Distance to nearest lot'line-'-.47...... <br /> ! <br /> Cesspool:� S��� Dium*tac� Liquid Capacity / <br /> -'ga'�[� --''--' �.' - '' <br /> P6"y: Distance <br /> `�nnu <br /> D�t nco wo|L-��_- �_-----'D|�mnu, from ne*n�+ ����g'--____--_''-'- <br /> ^ [] D��uncefonau�o� |o+ Um�----_--L-_-'_-.--_-__-__-_-'_---__.-'--_--�_-'--'-' <br /> / <br /> Remodeling <br /> -- � <br /> " � . ., <br /> ' and/or6o,c�6m\ <br /> � I...............�' -�- - <br /> ordinance�, St ws, anidules and r-egulations of the San Joaquin Locfl Healt-h District. <br /> ` ect <br /> (Plot plan, showing size of Io+, location of system in relation to wVel , �Vuildings, efc., can be placed on reverse side), sl_.� <br /> FOR DEPARTMENT USE ONLY <br /> - <br /> ! <br /> / APPLCAT|<}N ACCEPTED BY... .. .__--__-__-_ DATE' ����'���---_-- <br /> REV|EVVE� OY-----.__-._�^.-- �r--'''-'''- DA|�-''__'----'_---_.-__ --- <br /> BU|LD|NG PERMIT ISSUED----------------------------------------------------------------------------------------------------- D/g'E_'__---___-------'_' <br /> ' <br /> Alterations and/or recommendations--------------- --- ------------------------- -.__---___--------------------------------------------------------------------------------------- <br /> ----------------------------------------------_-_'---._-''`-_----._-.___-__-._--_-_-----_-__'_-------_.__ <br /> -'------------------------------------------------- ------------------------------------------------------------'--''--''---'----'''--'--------''-'--'----- <br /> '--------------------------- ------------------------------------------------------------------------------------------ -------------------------------------------........... ----------------------------- .... <br /> ----------------- '-'--------------------------------------------------------------------------------------------'---''--.'-'''--'-'.------------------------------------------------ --_ <br /> �� _ / / _ �� ` <br /> HN�L |N�PEI7|[n� 8Y�� / -- Date-'�s--'''-�'-''��''��~-''---''_-. <br /> L/ SANJOAQU|NLOCAL HEALTH DISTRICT <br /> � ~ <br /> 130 South American Street on0West Oak Street 1ooSycamore Street 205 West 9th Street <br /> Stockm"'c*/m""/" Lodi,California ma"temx'maxvwrnia. Tracy,California <br /> cap °"°"m, °'^" wMm'a/ ATLAS <br />