Laserfiche WebLink
` <br /> APPLICATION FOR SANITATION PERMIT � w <br /> � .� <br /> � <br /> (Complete in Duplicate) <br /> Aoo|icution is 6ena6y made to the San Joaquin Local Health District for u permit to construct and install the work herein described. <br /> TG application i 6 i |i ithC Ordinance No. 549 <br /> .~~ ADDRESS AND ^~ - <br /> �wmor mo <br /> ' <br /> Conf�c+o�s N --------_ --_____/ <br /> _- Phone----------------------------------- <br /> Installation <br /> _'__--__'__.. <br /> |n�oUaf�n will serve: ResidenceApartment House [] Commercial ETrailer Court E] Motel ] Other [] <br /> Number of baths 0 Lot -___.-_-_Numbaruf |i�ng units. <br /> n � . <br /> \ <br />' Water Supply: Public system 0 Community system F1 Private <br /> Character of soil to a depth of 3 feet: Sand [] Gravel E] Sandy Loam Clay Loam 0 Clay Adobe Hardpan [] <br /> ~ -TYPE''OF INSTALLATION'-AND-SPECIFICATIONS: <br /> (N� mepfl� tank permitted � �uW�owe�v, �oa°aUa�|* wlfhYn �O� femf.\ <br /> . ^ � <br /> S n�' Distance from nearest well �^n'°� Distance from foundation u <br /> ~ ~ ' -'^'""=~°' ' -+*�r�� '--^~~~-''~~~~'�p�''~~~^-� <br /> No. ofcompartments--.��_._-.-'Cmp*c|t�- --S�e.. .�[�[...Uqul� �opf�--�f�------ <br /> -Cpssoo6: Distance from nearest well-----------------Distance from foundation--------------------Lining material .----._-_-- <br /> n Size: Diameter_'---_.'''_---''_Deuf6 '_--_____---.__---- <br /> Privy: Distance from nearest well '-'__'--__._--__-_..Distance from nearest building�-'-�___-._--�-- <br /> [] Distance tunearest lot line------------------------------------------------ ^ <br /> 5enonoe Pit: Distance to nearest well ____---Distance from foundof|on--------------------Distance to nearest lot line----------------- <br /> El <br /> -__-._-[] Number nfpits----------------------Lining material-----------------------Size: Diameter------------------------Dept h----.__-_--_ . <br /> --' ~' ' Field: ~~'~~^` ^~^ '~~'`^' ~~~^-^~^~~'~~'~' from foundation -2~^ ~=~'^~ '` '~~r~' ~' line <br /> �+- <br /> Type of filter material---5 epth of filter material---------le------ <br /> 'Remodeling and/or repairing (describe):-------- ........ <br /> -_.------_____--..___.--__-___-.___----._____-----_-_____--___.__--_____--__-_-____.._. <br /> _-_--_.______--.___.--_______'_-___---___-____'_--___----.__.--__-_-._--____._ --- <br /> ___ <br /> I hereby certify that I haye, prepared this application and that the work will be done in accordance with San Joaquin Cou <br /> ordinances, S�tafe�Ilaws, nd Ades and regulations of +he San Joaquin Local Health District. <br /> _--------------­-- :T\ <br /> - <br /> By:----_-__--.___--------'--'-----------------''---(/itm)-'-'---'------------------' <br /> (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this applicarion). <br /> FOR DEPARTMENT USE ONLY , <br /> APPLICATION ACCEPTED BY' DATE � <br /> REY|�VVGD QY ����-.-_--. D�TE---- ��.-.---_-' <br /> BUILDING PERMIT ISSUED --------------------------------------------------------- DAT£ ---- ) \---/.-!----_--.-'---_ <br /> Alterations and/or recommendations:---- ------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------- ---------'------------------'-----'------'---'-'-----'-'-'--------'---'------' <br /> -'---------'-----`---'--'-----'-------`-----'---'---'-----------'-------'-- <br /> --___._-____---__---_...__--___-----__--_-____.__-__---__-..__--._--_'--___--_-.. <br /> ----------------------------'_-------------___------'_------'__ '����'����- �-�-��� <br /> PBRk [7 Nos� 3� 6ISSUED y- s-,(Dut� FINAL INSPECTION BY:_--� <br /> �� <br /> '-_'-- � <br /> Date--- <br /> SAN <br /> '-''—'-'-'--n-- <br /> JOAQUUN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> sS--9-2w 7-50v*/639 <br />