627 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT ' VIT (Complete in Duolivafo) App|ic*tiun is hereby made to the Son Joaquin Local Health District for o permit to construct and indu|| the work herein described. T6�� application ls made in comp|iancnwith County Ordinance No. 549. JOB ADDRESS AND LOCATION �n� �� EZ�� ---'f�° - ^' "='^`=,^ ------ Owner's Name--------- ----- ----------------------------------------------------- Phone-_ N ` Address--------------------4;^4,~ P-- --_------_--------.--------.---.---_----------_---_----.----.------'--_.. Cun+n,cfo,'s Name_------------ ' / ^4-C-,��P -.�S_L1B-`--PzA[Z-1 ..... Phone-__--____-..__- Installation will serve: Residence E] Apartment House E] Commercial [9- Trailer Court [] Motel El Other El Number of living units. F-1 Number of bedrooms E] Number of baths [] Lot size------- Water _mafer Supply: Public system F] Community system [l Private Q _~_ -Character of mx|i to a depth of feet: Sand E] Gravel El Sandy Loam P-"Clay Loam �] (�|uy �� /\6o6o [� Hardpan F� TYPE OF INSTALLATION AND SPECIFICATIONS: ' ' ~- - - -- - Az�- (No septic tank or cesspool permitted R public sewer is available within 200 feet.) SeVk� Dis+once f,om neanas+ weU-��^..Dl�once from foun6�tion-. ''- L'Y��L�.��.i��-��.L/�x�.�� No. of oompo�men+�__--____-..Cnpocit�- \�e a '- ' Uqu;6 depth_-.��` .--_- Cess000: Distance from nearest well-----------------Distance from foundation--------------------Lining mmfv6oL--_._-.__. �] S6o: Diameter--------------------------------------Depth---------------------------------------------------- Privy: __.__-._-----------------_-Privv Distance from nourAfwell -'------'---'''----'-_'Disfunco from nearest building.--'-''''--''__''._- E] Distance to nearest lot line__--_'-_._---_-._'-' Soepoge R+: Distance to noo,eo .e|L_''-_-''-Distanoo from foundation-------------------Distance to nearest lot line_'-_''_ El Numbe, ofpitu---------'Uninq material----------------------- Diameter Diome+or_---.--_---Deo+h--.--_----�-r�-—.-' . Qiw. Field: Distance from � ^ Oi�nn�vfv "=o,=v �� |ino.. r Ell" Number of'|in ' 'of'each,H VVi6+k offrench-_-- ��¢_----_. Type of fi|h,r matvrio| of filter material -_---- �� Romo6o|ing and/or repairing (describe):------------ ------------------------------------------ .--------------------------------------------------------------------------------- 49 ' ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- '-----'---'---'----'--------�----------'-----'--'-'--------'-------------''--'------- certify � | hmm prepared this that the *� �U � d�ein accordance v� S� Joaquin County � ordinances, State l hereby ~ ~~ and rules and 'mf the San Joaquin LocaHealth District. (S i g n e d) _5 3 ----- and/or Of ' -�''��_-.'''-_-(Title)-''__''-'_--__-__.''-_---_. (Plot plans, size of lot. location of system in relation to weUo, buU6ingo, etc.. must be G1a6 with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- -~��r-�� ---------------. DATE---.. -_---.- REVIEWED BY---------------------------------------------2------------------- ---------or�--------------------------------- DATE---..�{..��-��..��-�------------------ BUILDING PERMIT ISSUED--------------------------------- ------------------------------------------------------------------ DATE--------.---------_.______ AKen,fionsand/or recommendations:-----.------.--------.-_---_--__--'_--------------------_-________ -'-____-..__---___.-___.--___--___-.-__--.__-_-__---.___--______._____.__-_----_--. ------------------------ ----------------------------------------------------------------------------------------------------------------------------- ----------------- ------------------------------------------------ -------------------------------------------- -------------------------------------------------------------- �__-.. _ - PERMIT Nu�o`��__- ISSUED--- ' _- D*+n RN/\L |NSPECTON ~- ------- Date---------------- SAN JOAQU|N LOCAL HEALTH DISTRICT 130 South American Street Stockton, California sS-9-21A v'sm v*/639