Laserfiche WebLink
pOR _ FICE UFYE: ------ --�------~-� -'- � -�- <br /> - APPLICATION '���R PERMIT Permit K. <br /> ---- ' (Complete in <br /> ------------------ <br /> Duplicate) Date Issued <br /> Application is'shereby made to the <br /> 3mo Joaquin Local Health District for m permit to construct and install the work herein described. <br /> This ~rr'~~^^7' '" made '" compliance wnmCoun�' ��"d�mnoeNo549. � - <br /> JOB ADDRESS AND LOCATION <br /> ' . __''~~--^_-.��.«-^�'� '---__--- <br /> Owner's Name 41-VIII-1,6 <br /> 40 'en <br /> , -_-_-'-'_-_-~----_----------.----.---. Phone- ....'... <br /> �66"mo�---_ -'-''------���-----------'''-----'---'----'-'''------''-----'----'''--'-----' <br /> Installation willl�,serve: ResiderIce, Apartment House E] Commercial [] Trailer Court 0 Motel El Other El <br /> Number of living unnw; _j- Number ofbedrooms +7'.. Number of baths __/- Lot size - / '^4�Water Supply:.Swppky:.I Public system Community system 0 Private [] Depth to Water Table -------- ft. <br /> Character of ` El Smndy Loam [] Clay Loam [] Clay E] / 6obe]B Hardpan (j <br /> Previous Appli6afion Made: (If yes,date--------' --------] No` New Construction:,Yes []. No a FHA/VA: Yu CNo <br /> TYPE <br /> / <br /> ��F �N�T�LL�J|��Y� �4N0 �P���P���T|��NS: . <br /> (Nm axpfiu tank or cesspool permitted if public sewer is wvwUa6|e within 200 fwwf') <br /> S°p6cTank: . Distance from neurms+ weU------Di,tmnce from <br /> foun6ufion_------.Mmto,iuL---C- <br /> o -----'--- <br /> -pm'-cx-'�'-No. nfcomportmnnf�-..' -3|ze - '--'—'iiqui6 dnp�h '------ <br /> D|,posa| <br /> �w|d'� Distance ��m nm�rev �weU------D�f Distance from foun6mHon--_.-_._.-Distance to nearest lot <br /> LJ � /�m- <br /> . <br /> ^ -----Num6er of |�*x'_--�''-''''''-LonoH, �� ooch |im�'''_-.''''-_'VJt� u� tm*nc�.__ <br /> Ty9e of material., of filter +ehuL-_-,--_.Jofa| length_..--.------___ ' <br /> Seepage Rf/� Distance to D .. ' Distance to nearest |of ||nm.°�. � � <br /> El ���� � Number of pHs'_�^---Uning mato6a| cx��'-�ze: D� - <br /> Diameter �� <br /> "� .^ _Depth_-' <br /> -----_ �- <br /> Cesspool: Distance from nearest well .___..-Dis+unoyfrom foundation---''-------------Lining material .'--. <br /> LSize: D1ameh�'---.---_--.-Doot '''''---__-'-'''----'---L�u[d Capacity ----- <br /> Privy: D6tanoofnzm nooro, well'_''--'-''''--''''-''/'Distance from nearest <br /> -= - K* <br /> [] �' <br /> Distance hznearest lot line`''-- ^ <br /> -^. ~ <br /> __-__-_--�---'---'--_--'-''-' -'-' <br /> R mo6eling and/or repairing (6o�r,l��\�--x� <br /> � <br /> -- ....... ,_ <br /> '-.-___..'..~`,---------'------.----------------------------------------------------------------------------------- ------------------------------------------ -------------.--------_--- <br /> '----------------''----------'' ----------------------------------------------------------------------- ........ ------------------------------------'--'-- <br /> -'--'__''''-__''-__-__.-_-_____�---_-____-_---.__'._-._-__-.-_._--_-..___-.'--- <br /> I have - fhe�o, �U �a ��n� �nmmcordmncew�hSmn ----'----' <br /> ��� �� h� � r� � r����� � � Joaquin L� �� District. ~��' ~�"' <br /> (Plot plan, show Ing size of lot, lo to, f sys;,m in r, tion to wells, buildings, etc., can be placed on reverse side). <br /> FOR �EPARTMENT USE ONLY <br /> r`rruCA/IOn ACCEPTED BY ---------------------------------------------'' DATE <br /> RENEWED ­:�---- ----------------- <br /> BY <br /> 8U|U]|N�� PERMIT ISSUED-------------- ��~-_-_--__-.-_-___--`-__-_. DATE'-'_--� ''T'---'--'----- <br /> Attwrotonwand/or re*nmnnnend'a+ions:......:--—-.-'.7------------------ ------------- <br /> --�-'�-�`------_---..-.-_--_---_____ ----�' ' <br /> ���.�.--------. <br /> ` ----------------------------------------------------------------------_''''-'-'-------------------------- ---------------------------- ------------------------- -------'------------------------- <br /> ------------_-_-`'-''-_.---''-'''-''--'''-'''_'''--.''''-__'-''''__.''-_.''_--''-_.''-__--''--_-.-'-' <br /> ----'----------------------------------'---------'--------'''''''-'--'-'--' <br /> -'-'------''--' -'-'----- ' - <br /> -�- <br /> ------------ <br /> -------- <br /> '-- <br /> ' <br /> .-'''-- '''.'-'' <br /> -'' <br /> HNAL /NSpF610N o, Dmto-'' -------------------------- <br /> SAN <br /> '-_-''_- <br /> SAN JOAQU|N LOCAL HEALTH DISTRICT . <br /> 130 South American Street n00w°mOak Street <br /> 12vSycamore Street 205 West 9th Street <br /> Stockton,California Law[,California Manteca,California Tracy,California <br /> ""'51 °E"""" "'°" um °=` ^,`^" <br />