Laserfiche WebLink
fOR OFFICE USE. <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> ..............-----•-•-••----•-- --------- ------ !Complete in Dulakefe) Date Issued------------------------------------•--------__.- ThisPermitExpires I Year From Daft Issued <br /> Application is hereby made to the Son Joaquin Local Health District for a permit to construct and inslall the work herein described. <br /> This application is made gco�np6!c!with County Ordinance No.W. 02-9'C -0--07 <br /> - ' <br /> ?t <br /> JOB ADDRESS AND LOCATIONZZd*1v2&u ------- <br /> Owner's Name <br /> ALI-'I <br /> Contractor's Name___4_.W__ <br /> histallefion wig%am: Residencejo Apartment Home 0 Commercial EI Trailer Court 0 Motal 0 Other E3 <br /> Number aF IWmg.units:.t..._Number of bedrooms Z7_Number of baft 3.P-Ar Lot size Ifo-rte9 <br /> WaterSuppfy; Public gyskwn0 CommunitVsysfern,C] Private M Depth to Water Table#q ft. <br /> Character of will to a depth of 3 feet: Sand 0 Gr"0 Sandy Loam Pa Clay.Loam[2 Clay 0 Adobe[3 Hardpan[3 <br /> • PI 0 <br /> re4lous Application Made: (if yes, No 0 New Conatructiron. Yes Q No[3 FF4A/VA.Yes 0 No <br /> TYPE OF INSTALLATION AND SPECIRCATIOM: <br /> (No septic tank or cesspool pwrdFHed FIF public mw Is available willhin 20 foot.) ff <br /> Septic Tank: Distance from nearest welL__J4r*__'___Dist from <br /> jvNo.of compartments-A*........ ........ A. <br /> Disposal Field: Distance from well -!—Distanm fromfouadationl&- _.Distance to nearest lot IhW_r__ <br /> 19 Number of <br /> -----------------Length of'eac;IinaF0._j__jr__Width of <br /> Type of fitter material,00X-__ff0dbapth of filte;material.14?------------Total Wngth_*_............ <br /> Seepage Fit: Distance to nearest from to nearest lot <br /> El Number of pits------------ Diameter_— ....--.___---Depth.............._.---_-__ <br /> Cesspool: Distance from nearest weff_._____._Distance from foundation----------—Lining <br /> Size. Diameter....................................Dapth.-------- —------------------------Uquid Capacity--_-.-.----_9ak. <br /> Privy: 4 - Distance from nearest won ...............---------............Distance from nearest building------------ <br /> [3 Distance to nearest 6f line.----- -------------�� — ..- ».-»..».. __— <br /> Remodeling <br /> --------- <br /> Remodeling and/or repairing ...... <br /> —---------------------------------- <br /> ---------- <br /> .......... ........ <br /> I hereby cer0v that I have prepared"application and that the work will be clone in accordance with Sea Joaquin CCU* <br /> ordinanow Sfato lim.and rules and regulation of the San Joaquin Local Health Distrid. <br /> -----------------------40—and/ar Contracted <br /> ... ..._---•------............... <br /> (plat plan.%howing size of 64 location of system in relation to walls.6alldings,ate,can he placed an reverse side!. <br /> FOR IMPARTMENT USE ONLY <br /> (' ra- <br /> APPLICATION ACCEPTED BY-------------------- ----.- BATE...................6z.-A ---------- <br /> REVIEWED BY......._ DAM-------------------------------- <br /> BUILDING PERMIT ISSUED <br /> Ahefi.andlar <br /> ................................................... <br /> .........------------------------------------------•------v-- ----------- ------____------------ ---------- <br /> ....................................................-----------------------------------/*V---I�-4.-;-_k_-__.--__0. <br /> FINAL INSPECTION --------_------ <br /> --------- - - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT f <br /> 730 SNAb AnMUM 90 eel 460WV*09%5e w I24 fr=MWO Stma ?as We.*916 5"o <br /> Steddw%Contmb LWIL cenramia mat"em canfewdo Ttetv."IfurnJa <br /> ZS 0"./1*6.6-e9 IN Y41 A"U <br /> 4 <br />