12559 - Laserfiche WebLink

Home Browse Search

APPLICATIONFOR SANITATION PERMIT Permit �^ N*` - 2.....=.._/ ��m"np�f� �n Om��o�� / `This PermitExpires I Year From Date Issued Date Issued ------ Application -App|icution 'is honn6y made to the San Joaquin Local Health District for m permit to construct and install the work herein 6oxx,i6oJ. This application is madein |ih County Ordinance DD ADDRESS AN LOCATION_ � Contractor's Nume.-'---_y~JH��0J�^D��._-_---__-.__-_------.--------- Phone--------- --._---- |nstaUationwill serve: Residence g Apartment House Commercial F] 7raUa, Court [] Motel [] Other [] � � Number of living units: .__V---- Number ofbedrooms ,^�-. Number of 6u+h, ---��- Lot size -6�zs�-)�'ZKV___---_-- Water Supply: Public system E] Community system L] Private X Depth to Wafer Table A'�__ ff. Character of soil to a depth of feet- Sand [] Gravel [] Sandy Loam4jQ Clay Loam 0 Clay 0 Adobe [] Hardpan � Pn,"iwuu Application Made: Yo, [j No 9_ Now Construction: Yo,Url No [] FHA/VA. Yoo & No TYPE OFINSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer & available within 200 feet.) / � abAWD Septic Tank: Distance from nearest well--- Distance6o � No. nfcompn�mento-..��-.-- -.Size,��-��.��'�-_Liqui6'��Rf�-..��-----Cupu�ity 91 ni-C / i ��Q Disposal Field.` Distance from well..-S-0------Distance from foundation-----10-----------Distance to nearest lot �0 Number of |�e, '�� Length of ooc� | �� of +�n6`''x�.� '_-----. Type of filter material- ---Depth of filter material .--- .........---Total length--2_i_0.-._-__ Seopoge Pit: Distance to nearest woL-'----''Distonce from foundation'--.''-_-Distance to nearest lot line`--'-'' E] Number ofpits----------------------Lining material----------------------- Diameter --_---Depth-----_--- Co, pov : Distance from nearest well----------------- from foundation ---------------- Lining mn+rhoL-.-'-''-''--_- El Size: Diameter-------------------------------------- ----------------------------------------------------Liquid Capacity.-_-_--_.gals. Privy: Distance from nnom, well''--''--'''-''- ----------Distance from nearest building.'_'-_''-'-_'-'-- El Distance tonearest lot line-_-_---_---.----..__..__.--'_.----_--_._----_---- ~-�~ Romo66iog and/or repairing (describe):--- ----------------------------------------------------------------------------------------------------------------------------------___' ---------- '. '-----------'—'-----'-----'---'---''------'--'----'---'----------'--'----- / ---'''--'---''---''--'--'--''-----''------'-'-'''--'----'----''-''-'-'-' - ' . ' �--''''--''-''''''-'''-''-'--'''----''--''-''----'''------''--'''---'''--''''--'--'-��'-'��- ---- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances. Stat, laws, and rules and regulatic S of the San Joaquin Local Health District. ----------- (Owner and/or Contractor) . By:. --_--__------_.. �--___--_--_-._._---]T��i._-------'_---- -- ----' (Plot plan. �* g size � �� m � �tem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ' v ' � `KEY|EVED B I .----_-.---.----' DAJE-- �� -'-----'-----� BU|LD|N � PERMIT ISSUED------------------------ DATE------------------------------- -_---._-- Al+era6onsand/or recommondm+|ono�'�0e��. -��'��-_-- .Z------------------------- ------- ----------------------------------------------------------- '_-----------.-_-.__._-----_-._--_--_---_-_-____ -'-----''' '-_.'' - _'- - .--- ---� --' - �~-' -' -� —v' ---'--�--------' ----- -. �o ��;�c�^�.-�_��^��--.��-c -..'el�,..- �-�-�=,.`- �'��.. ^ _~ ( u' ~� ~~� F|N�L�y �|N� � -- PBCTON 8Y�---''--'''-''''''-'-'---'- Date--''''''''-'''-''-----'---'-'-' SAN JOAQDUN LOCAL HEALTH DISTRICT /no o""m American Street 300 West Oak Street /az Sycamore Streeow m"*h 'rr Street St"=*"". C"n;v,"/° Lodi. California Manteca, California Tracy, California c`p-em m~'"a 9'59 ,zc". -----