SU0003238 - Laserfiche WebLink

Home Browse Search

s APPLICATION FOR SANITATION PERMIT Permit No. .../..Zj-/..4 L,�./ (ComPbfe In Duplicate) yy Date Issued ;cation is Mrrby media to the Sen Joaquin local Health District for a permit to construct and Install the work herein described. applicafian is media in compliance with County Ordinance No. 54,. ADDRESS TION .1.7g,. . .. A {"+�/.( aS' d sr's Name..... ...._ .. . ....... .... ..Q.L.1/................................ 'Phone -7 .... _.............. ...._...:.................................. / r racier s Nome—i4......_.. r... Nurn .fi! .. .yT..`l.l. ... .. .... .AC.. 1.. ...5 Y.tC....... Phone .. <.. t5 ,Lc� ,boon Willi srrrias ResidencApartment House ❑ Commercial ❑ Trailer Court ❑ Mote//l��❑ Other ❑ Number of living unite: .. bar of bedrooms ._ . Number of i........ Lot size ......L/.mac". - ,r Supply: Public system ❑ Community system ❑ Private Depth to Water Table ........ ft. act"of Will to a depth of 3 foot: Sand ❑ Gravel ❑ Sandy Loom❑ Clay Loam ❑ Clay❑ Adobe G—Hardpan❑ esus Application Made. Yes ❑ No ❑ New Construction: Yes ❑ No ❑ FHA/VAS Yes ❑ No ❑ OF INION AND SPECIFICATIONS: ( tc fork or cesspool permitted if public"war is available within 200 feet•( c �.,Ik:f Distance from nearest wail......... .......Distance from foundation...................material.......... . No. of compartments............. ..... Size................................Liquid dept l....................... Capacity................�.._•... ysal Distance from nearest well, Q Distance from four. 4stion... Distance to nearest lot Number of lines... ...... e { � tt Length of each line._..J.Q..... r _.Width of trench. s.�,.�..C!..".",,,,,�. Type of filter materia loL7k ... QDepfh of filter mebriel.... . p Total length../�.!....... ................... s �.0....... e it; Distance to nearest well.L.O.D..,(......Distance from foundation.l.j. c qg c to nearest lot lin _.... _ Number of Pih......I..............lining maferial..P.em .,..,Size: Diameter.... Z5.,....Depth...r.Z..�! Pool: Disfanco from nearest well.................Distence from ounda}ion. ........... ...Lining material... . .. . v' ] Size: Diameter. . -• . . . .....Depth......... ... . .._..... .. ........ liquid Capacity. ...... . . gels. Distance 'rom noarest woll Distance from nearest building. . .. ] Distance to nearest lot line .... doling and/or repairs gf scribe(: " . ..:.. / Jv, :: yCt�. tri. . . .. ... ..;c ,�.�...... � . I hereby e}kfy loaf I here preparedRhis • plication and that the work will�ne in accordance with San Joaquin County en S} lawsr"e rubs end re ubfiops6 of the San Jo quln ocel Health' D1 }. ` •• ,{Qwaugse�,6r Contractor) By;........................................................ k .. t sfle(.............. plan, showing size of lot, location of system in role ' Is builain a, c. an be placed on reverse side). EPARTMENT USE ONLY -ICATION ACCEPTED BY .. ....................................... DATE .. -- EWED BY.... .._ DATE )ING PERMIT ISSUED. ...... . - . .... DATE a}ions and/or recommendations:. .. ... .e'fi_. .. .. ... . .. .. __ . - AL INSPECTIOIJ 9K ��TyL�L7, ��'i7 Date &.'. .S SAN JOAQUIN LOCAL HEALTH DISTRICT / 130 5o0h Amailcan Sfreef 300 Wait OaY Strut 132 Sycamore Street Y 814 North "C' Street y StocMon. GCfomla Lodi, Glifrrnla Manteca, California Trecy. California