Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT <br /> —[Complete in"Duplicate) <br /> t _7_ it and 'install the work herein described. <br /> Application is hereby made to the San Joaquin Local Health District for-a perm __V_ <br /> mp I ou -0 rclirfance"�Fo.'549.-- <br /> T4ii-a01iZ_af,16h'is_rrl�i_dd �h c5' with C �i"y <br /> ---------------- <br /> JOB ADDRESS- ANLDOCATION-------v- ------W/i, -------- -------- <br /> ----------------- <br /> f?(�? A <br /> -------- ---- ---------------- <br /> Phone--- <br /> ---- ------ <br /> Owner's ............ <br /> Name- <br /> - ------------------------------- <br /> -------------------- <br /> Address---------------- ---------,rte- <br /> ---- ------ <br /> �--- Phone <br /> -Contractor's Name----------- ------ - - ------------ <br /> Residence Apartment House El Commercial E] Trailer Court 0 Motel E] Other El <br /> .Installation will serve: Lot size <br /> _/-1 9------- <br /> Number <br /> 9---------------------- <br /> Number of living units: My Number-of bedrooms JZ. Number of baths Vf X <br /> Water Supply- Public system F1 Community system El Private [_1 <br /> Gravel Ll Sandy.Loam El Clay Loam ❑ Clay E] Adobex_Hardpan El <br /> Character of soil to aepth of 3 feet: Sand 0 <br /> kAj <br /> TYPE OF INSTALLATION AND SPECIFICATIONS:, <br /> permitted if public sewer is available w4hin 200 feet.) \3 <br /> (No septic tank or cesspool pe f _Z---------- <br /> from fcundafionAzt�6/-------M. <br /> Septic'TSnk: Distance from nearest wei; _-2-miquid depfht-�Z1--,-L- ------------ <br /> No. of compartments__ jj ity-------- K" ... <br /> 91 -_ -ViQ-------Cap�� -----------------Lining material-------------------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation----- <br /> ---------Depth------ ------ --------------------------------------- <br /> ❑ <br /> Size: Diameter----------------------------- st nce from nearest building__-__._______.._________-_______--- ------- <br /> Privy: <br /> Distance from nearest wejl-------------------------------------------------Di. a <br /> -Distance toinearest lot line________.__----- -- ---------- ------------- <br /> ❑ <br /> ---Distance to nearest lof' ine,-7 <br /> Distance to nearest weil--- 4�1--------- <br /> Distance-from foundation • ..: <br /> ------------------ <br /> Seepage Pit: <br /> --------Dept k- <br /> ning materi6l_Cr/j <br /> Li Size: Diar�eterl <br /> % umber of pits---- Ar :,�r2_t----Distance to nearest lot line_,�__42 - <br /> A __. - -from foundation__-fion_�,/_ o <br /> Disposal ReU. .-Distance from nearest ---.-.Distance trench-,/ <br /> Width of <br /> ifs ---------Length,of each Iine�; _7�------- <br /> Number of lines--Cz- - <br /> Type of filter material - <br /> , Depthof flfemateria <br /> � <br /> 4 - I . , ,�1 (.2 -- ---------------------------------------------------------------------------- <br /> R ­�repai' ng (describe)------------ --------------------------- .1 1 <br /> emocle�ing and/or repairing C0_ _CC7VV __Ij ------------------------------------------------------ <br /> - --------------- -----------------------------------I--------------------- , N� --------------- - ------------------------------------------:- <br /> -------------------------------------------- <br /> ---------------------------------------- <br /> ------------------------------------ ------------------------------------ -------------------------------- <br /> ---------------------:_:%----------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------- I- in accordance with San Joaquin County <br /> licatio an that the w I will be done <br /> I hereby certify that I have prep ad this applicatio V <br /> "ca'"o <br /> 0 Lo al <br /> -,-,,-ordinances, Sfa aws, and rules Ad r gulaflons of Vfh -San Joaquin 71 a Health District. <br /> :7--' wner incl/pfr/Contr ctor) <br /> ---------- 7" <br /> ------ - ----- <br /> (Signed)----- - ---------------- i le <br /> ------------- --------------- ------ <br /> By:------- ---- ---- - ---t-_-- ------ -------- file h this application). <br /> etc., must be filed <br /> (Plot Plans, showing size of lot, location of system in rel ion to wells, buildings, <br /> FOR DEP' 'E ONLY <br /> DEPARTMENT USE <br /> -------------- <br /> k/ DATE <br /> APPLICATION ACCEPTED BY------------------------- <br /> REVIEWED BY-------------------------------------W---V7 ------------------ DATE------- -------------------- <br /> - ------------ <br /> ------- ------------ -- ------- <br /> BUILDING PERMIT ISSUED----------------------- ---------------------------------------------------------------- DATE---------------------------------- -------------------------- <br /> ----------------- <br /> -------------------------------------------- <br /> Alterations and/or recommendations-------------------- ----rl_�----------------------------------------------------------------- --------;�---------------------- <br /> -------------------- -------------------------------------- <br /> ------------------------ -------------------------------------------------------------- ------------ -------------------------- - <br /> I------------------------------------ ----------------------------------------- --- ----------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> ---------------------------------------------------------------------------------- ------- <br /> ------------------------------------------------------------------------------- <br /> ---------------------------------------- ----------------------------------(Date) FINAL INSPECTION BY:-------- Vl�-------------------------------- <br /> PERMIT Nof --7--:;r ----- ISSUED----- �'�--=�,'--------- <br /> Lf <br /> Date------------------------- ---------- ---------------------- <br /> SAN JOAQUil N,LOCAL-H EALTFl,-DI STRICT <br /> 130 South American Street <br /> Stockton, California <br /> E5-9-2M 9-50 W-1639 <br />