Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT Permit No~�_ <br /> , ---------_-- <br /> (Complete in DopUcmfw) at* |ouo6 -« <br /> . ^ <br /> the work <br /> � described. <br /> /,- 41 0 - <br /> � <br /> This ~rr^~~^- is made.in —''-���� ' - � - <br /> --- <br /> r's Name <br /> ------------------------------------------------------------------------------------------------------------------- <br /> , nou="s-_-- --° � <br /> Phone----------------------------------- <br /> Contractor's N -x�'-1^-�' ---'---'-----'- <br /> � <br /> Installation will serve: Residence ` HouseHouseE] m <br /> Com �� E] TrailerTraileCourt� E] | El OtherOtherEl ' <br /> � <br /> Number of |i�ng`unHs: /.~~Number of 6e6nzono /-. Number / -------- - ---- <br /> Private to Wafer Table .1-0- H` <br /> Water Supply: Public system <br /> ��n <br /> Character s� to m n� of 3 feet: 3 Sandy Loam Clay Loam 0 Clay El Adobe C] Ho <br /> Previous �, Made: Yes F1 No [?_�� Construction: Yes 8-90 U <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic /mnx or o=",po= pe'""''°" if public sewer '^ ~`~'--- within- -- <br /> � SDistance from nearest *eo ---------- ;c <br /> Disposal ri D�stance from nearest <br /> Number of lin _ <br /> ----- <br /> Type ". filter "�='"'''�,^^^-~-~�-~`r- - -filt- ---rial—'--w - ' <br /> Seepoge Ht: D�sfonce to nearest *aL''--- `_-'Didnnua from foundation-------------------- to nearest |cf line-'�__.- <br /> [� Mvmber of pits-------------------,.Lining mot.ehoL_-_--..Size: Diameter __---_--Depth--------------------------------- <br /> | material <br /> Cexo`oo : Distance from no� o Distance from ,o""d". o" Lining '' <br /> [� Size: Diameter Depth Liquid `~p~~'''----------------------------gals <br /> Privy: Didancofrom nearest well-----------------------------------............. <br /> Distance from nearest building. . --.- <br /> El Distance tonearest |otline----._--'---'---------------'--------'-'''---'--�~�w^ <br /> . � <br /> Rumode�ing and/or repairing (describe):---r--------'_-.-------'-____-.--._--.__'--________..___.--_. <br /> � -_-._.__.--_''_-.-_-_-.--'-_�--_.'__-_-_---'---'-__'--_''___'--__''-'--�'-__''___-------_.'''. <br /> ' <br /> ------------------------------------------------------------------------------------------------------------- <br /> �'���____���___��'������'�������'�_���__��'_����_��_____����'��__�__��_���_�� <br /> --'-------'I hereby ' that | have preparedH`is application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)____-_*_94--------tt.� C��4�----------------------------------------------------------------------------(Owner and/or Contractor) <br /> (Plot plan. showing s�ize of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY� <br /> ATE ��-����� �~=� <br /> ' /\PpUC�T|(�N ���EPTED BY-----' '^�^------'--'-'---- ---`v°��/'- <br /> - ' D/H�-. ' <br /> REY|E�/ED BY-_''_--_.�''-'_-_--'--.'-'-_.'''-'�-'-'-_.'-'��--'''__ '''--''-'---'-_-_-_-_-'- <br /> ��TE <br /> BU|LD|N�� PERMIT |S3UED_-'''__'-'---'''''''-'-'--'-'-_'___'''-_�-'-' _-''_--''___�-''__________ <br /> AKu,a��ns un6/�, recommnn6uGonm----------.------_---------.---------.--_-___._________.__._ <br /> � '--------�����.���'��������������.���.���.����������������'����������..��.���.��.�. <br /> __.�-'_''''-''---------''--_''-_�--'--'-'��--'-''''-_.'-'---''''-_-.'''''_---'-__-''--''__--_'---' <br /> -' _-_-_.--_.-__-'--_-.-----'_.__-__-._._-_--__----------_---_-._--____. <br /> � ---------------- <br /> � ` ECT|{}N BY:_-- '. Date----.-� -.- -"�.--�~�'_.---. <br /> SAN J[AQU|N LOCAL HEALTH DISTRICT <br /> /nx Sycamore Street ' 814 North "C" Street <br /> /m South American Street 300 West Oak Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M u's/ xa.iso6 vv-2100 <br /> � <br /> _ <br />