Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
111C 1: <br /> - ~ <br /> � SANITATION ������ Permit N� <br /> FOR ��� <br /> (Complete in Duplicate) Date Issued <br /> - , <br /> Application is hereby made to the San Joaquin Local HeuiH` District for u permit to construct and install the work herein 6wm:rGxed. ' <br /> This application is mo6a in compliance with County Ordinance No. 549, <br /> JOB ADDRESS AND LOC -- ........................................... ..................... <br /> .'_ <br />' Ownor' N Phone <br /> 7 <br /> Contractor's Name...................... _�-..�,,� �-e� --*e�rz� ...................... Phone............................. <br /> -- \ <br /> Installation will serve: Residence E] Apartment House [-] Commercial TmNer Court El Motel El Other El � <br /> Number of living uo ^ : -� Nu^ ber of bedrooms -_—n Number of baths - Lot size -----_------- <br /> Water <br /> _--Wafer Supply: Public system unity system [] Private C] Depth to VVmtmr Table lrnl��t. ' <br /> Character mfsoil 0om-dopfhmf3feet:� Sand C] Gravel C-] Sandy Loam 0 Clay Loam [] C|uy [] Adobe[j Hardpan C] <br /> Previous Application Made: (if yes,date-------- - --------> No Now Construction: Yes p9 No [] FHA/V' .'Yes [3 No J3 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ' <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) . <br /> 3~ptio Took` D|atnnxo from noom,t woU--°�~_-Diotonco from foundation...� ---��m | <br /> Nu ofcompurtmmn'ts--.-- Size... ---Liquid 6ep�h----------- -----------Capacity------- <br /> Disposal <br /> ---D | Field: Distance from nwu,e, well---~~--------Distance from foundation-_ Distance to nearest lot line..........Z~°C* <br /> Number of lines Length of each line...._-. ..�-...Width offrench / . <br /> Type ofG|tormmter7oL. .-Dop+h nffilter material -.." `.'..Jofo| length--------��~«50--------------- <br /> Seepage <br /> F�' Distance to neu..~. . . _ _~_-. . _-._ ... __-_-- to nearest lot line..� ' <br /> Nvm6eiofp��.._/----.�-Uning materia Size: D|umote,-��.`.�---Deot6-..��-s�_-_-�-!- <br /> : Distance from nearest well-----------------Distance from foundation '-'''-'-Lining ma+e,iaL--'-'_,�_--__ <br /> [] . Size: Diameter--�.�---.-�---_-----Depth----------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy, Distance from nearest well-------------------------------------------- ----Distance from nearest building---__.___._---- » <br /> [] Disfuncetonou,esflo*||ne'--'_-__--._-----_..____-_'-_.._---.----_--._.__--- <br /> R°mo6oing and/or repairing (de . . �'--'_--'----''--------'' ---_' ---------------------------------------------------- <br /> ---'-------------'-----'---'-------'--------'------'--------------------------------'------'' <br /> / <br /> ---------'--------------'---'-------''—'-'-----''--'------'-'-------------'---' <br /> -_-_.° <br /> --.--___.-_--'___- ---------------------------------------------------------_-__._-_.__-_---_----_'--'.----- � <br /> / FOR DEPARTMENT USE ONLY � <br /> ordinances. e laws, and rules a gulaffions of the San Joaquin Local Health District. <br /> tSigned). .&,:.,g -------- --- ------- ---- -------------- ------------------------------------------------- ----_-------- .......(Owner and/or Contractor) <br /> (Plot plan, showing size of lot, location of system in relation to wells, building'i,.etc., can,be placed on reverse side). <br /> � . <br /> .^,.^..~ BY -. ` <br /> TE <br /> ------------------------------------ ------------- ---- --------------------------------- <br /> ---------------- <br /> FINAL <br /> '-'--'--'-- . <br /> � <br /> FlN^�L INSPECTION BY:--� ''�'..61 _-.- D�te--- .. � ---_---.—� <br /> - -�r -�~�-� ' ` <br /> / c��} - <br /> ' �~.. J��J�U|N LOCAL HEALTH DISTRICT <br /> 1uoSouth American Street wvpWest Oak Street 124 Sycamore Street 205 West 9th Street <br /> . <br /> Sto^xto"'cmxvom/m Lodi,California Manteca,California Tracy,California <br /> = 9 REVISED B-159 u" v'°` ATLAS <br />