Laserfiche WebLink
da <br /> i <br /> i FOR OFFICE USE <br /> {� APPLICATION- FOR S.A,NITATION PERMIT Permit No. <br /> y <br /> . .... .r ... (Complete In Duplicate) Data Issued <br /> This Permit Expires'S.Year From DAte Issued " <br /> A I¢ation h herebymeds to the Sen Joaquin Local Health Dis#r(&for per it to construct d install w rl herein described <br /> Thisapplicationis mde in compiianu withCountyOrdinance No. 549. � <br /> JOB ADDRESS ANNLOCATION..I&s.I.1,444...r6�.�,•• -•^" <br /> Owner's Na e.... .. ... .� .. a -trrs--��............... ... ... ................. Phe <br /> Address <br /> Controc ................... <br /> ..._ .. . .' <br /> ...'..' ...rl./ ......,1 ..1.YFr.....v <br /> ai.. .." .. <br /> . <br /> fl .. ..... Phono....... <br /> ..7y <br /> .. A .............. ......... <br /> tor's Name ..... . .Y. <br /> Instellafion wAl sarv) .Res;genc tpartme }rUOIIe [3, Com marc 1 ❑ lmiler Court ❑ Motel ❑ Other 11 <br /> 9rtI <br /> Number of living uhds .�.. Nu bar of bedrooms .f•'. Number f baths ..�... Lot the ...0 e�l.T f <br /> Wa}er Supply Public s s m Q' Corljmunity system ❑ ' Private epth to Water Table �Glft. <br /> Character of sof{ to a depth of 3 feet: Sand 0 Gra el❑ Sandy Loam❑ Cley Loam .Clay❑ obn Her n ❑ rn <br /> Previous Application Made: (if yes,date. ... . ... . )„�o ❑ New Construction: Yes ❑ No FHA/`'lA:'Yes❑ No Q <br /> TYPE OF INSTALLATION AND SPECIFICATIO,p15 <br /> (No septic fank'or cesspool permitted if p�uhqtfc,�wer is available 'within 200 fee/tt.��) <br /> " Septic Tonk: Distance from.nearesi wall la/6/�r ..DistencF fro�founoaj on_�rl. ...Materiels . ....._. <br /> �/p� Yr`� <br /> No-"of.compartments 'Ft .. izery� � �..r. Mid,depth 111`3� Gipeaty y ss <br /> t' D's o al Fold. Distance from peer s+ well/M Op Distance from.t'a:.rdetion. LP �Distance to mares+ lot ling <br /> 1 p 'Lsn th of.each I;nc..... .47... Width of trench . 44" <br /> 8e Number of lines 9 � �/�..r.Total len th <br /> Type cf filter materia ...DApth of filter nateria........ 5 <br /> :. i � <br /> • Seepa.no Pt: Distance to nearest wall Q . .:Distance from oandetion..:��Q �Distancc to nearest tot line ,Il <br /> Number of pi+s..f .. t ning mderial ✓Zo .. Size Diameter 6... Depfk.-f-j-- • ' <br /> Cesspool: Distance fiom,noaros II ...... .. Distance from'o.rndafion - Lining material- <br /> Cesspool: <br /> aterial ; t <br /> ❑ Size: Diameter. Dadbf Liquid Capacity <br /> gals <br /> . , <br /> Privy: Distance from vei .:. .Distance from nearest bwldmq <br /> Distance.$nAtares Ij Im =..t. .�..+ .............................. .. <br /> #^ <br /> Remodeling end/.S 4091 1Toscribb(r � . ... ....... ..... <br /> .. <br /> L /............ <br /> I_hare r rthy ihrit ( havg }e�pared this epplieation and that thew rk will be done Icordenee with Sen JoaquinaunL, <br /> �y <br /> t' I-Health District <br /> ` ordmencas6yS+� awsruleiid regafefions of +hen <br /> i e e�la} <br /> r• 4T <br /> [Signed)Krar9 . ' T9�if .tf ....... lr C <br /> .. ,�pryesv ar ontlector( I` <br /> i '�Cl�TIC.TANK SER�IGE Q',t ... ;114 ..a� <br /> an -howin hsizer Avco-,.HGL&38xf cyst ... ati r/� y <br /> .... _...:.. _.�.... f. <br /> (Plot pian.;showing.sire of lot, location of system in relation t wells 6ei'4.ing6, of can be�placed on reverre.side(. <br /> FORDEPARTMENT.USEONLY <br /> t1fii <br /> Y 1' <br /> T• d APPLICATION ACCEPTED BY -� ......................... DAT V <br /> ` <br /> REVIEWED BY ... .. .. <br /> %i BUILDING PERMIT ISSUED .: DATE..... <br /> - .. ..._ - L..G. f <br /> ` A+A:an mendafions• �..rf ���. YC.ik8.... -- - •'-""""""""""' "".... ...................�r,,,,0 ............... ..... <br /> .. <br /> FINAL INSPECTION. BY:..........CJ,.. ..................................... Date..... ............. . .-.. .. <br /> ,I <br /> s" SAN JOAQUIN LOCAL HEALTH DISTRICT - <br /> ]00 Wer,Oak SI-1 124 Symmers PrIff 203 Wer,0h 511.0 <br /> 16e1 E.14..It..Avr. Caiifurnia <br /> �y a Lodi,Ca Glarnin Menbre,Callrernia fiery• <br /> i 5wak,en,Callremia - <br /> y <br /> 1� r <br /> r.n <br />