Laserfiche WebLink
� ^ - <br /> ' ~ ^ <br /> FOR CE �V�� ���N��� <br /> APPLICATION� �"~"~""~~"�w"" /�(�_ <br /> ( '"' =- Pe,�hNu"~ /- .,u,�. � <br /> (Complete in TNw�cmt� - --'- - <br /> , ��� <br /> Date Issued <br /> ..�' <br /> ` <br /> . by made tothe San Joaquin Local Health District for o � to construct and install the work herein'des ibed. This application 6w in compliancewith CoJOB ADDRESSAOCA,�ODN --- Ord N 549 6 Rulesand Regulations: <br /> | <br /> -------- ---- -----------CENSUS TRACT --------------_------_- <br /> Owner's '`~^~ <br /> - -------------- ------ - - ....­ --- ----42 %_V------ <br /> Address <br /> ' <br /> Contractor's Name . <br /> � -- <br /> Installation wiU serve. ~~ Residence/ , . rtmentHowne-C] Commercial OTrail&Court ',0 A <br /> " <br /> Ao`/^e/ [_-1 Other <br /> -------------------------------------------- <br /> Number of living <br /> '--_--'_—'----'_Nvm6o, cf /iving uni$../-.. Number ofbedrooms '0Z-----Garbage Grinder <br /> �------------ Lot Size <br /> ---'� <br /> �----- <br /> ---. <br /> Vote, Supp/y. Public System and name '---'_-_-. - -----.-_.--_----_'_.----'-_'----_-Pdvo.~>< <br /> Chof i depth of fee/ nd� h - ' - Sandy _- Clay, _- <br /> Hardpan— Ej| '--- <br /> .� <br /> (Plot plan, showing sue of lot location of system in relation to wells, buildings, etc. must be okacm6 on reverse side.) <br /> | <br /> NEW INSTALLATION. (Nu septic tank or seepage pit ponnhfed if public sevvo, is available within 200 feet) <br /> ' <br /> PACKAGE TREATMENT { ] SEPTIC TANK![ ] Sirm -- Liquid .Depth -------------------------- <br /> --�---.-'�.�.�-----. _-_. <br /> Capacity ------------ ------- Type -------------------- Material-------- ------------- No. Compartments -,--.-...-- <br /> / <br /> Di$nnce to neomm` Well ----------------------------- ------Foundation ---------------------- Prop. Line .,�-_-..`------- <br /> ' <br /> «_ LEACHING LINE [ ] No. of Lines -------' Length of e6'ch ||ne---_-__. Total Length --------------------- ....... <br /> | <br /> ' 'D' Box ��-�-��� Type Filter Material ---.-_.--DooHh Filter Material --------------------. � <br /> , <br /> Distance tnnearest: Well ------------------------ Foundation --------- Property Line- .-_----'----. <br /> | SBEPAGE PIT [ ] Depth .----.�- Ononne�r —'---_' Nbn�ba ��—������---_ Rock Fi|�d `^ yes �] Nu �] <br /> | ---------~- ` <br /> ` <br /> Water Table Depth ------------------------_ �� -Rock Size ----- --~ <br /> �� -_ <br /> -------------- <br /> Distance to nearest: Well -----------------'----------------------Foundation '---------- �-_'r'|u-p. Line <br /> ne <br /> �--'___'-_ <br /> ` S�u/c Tank (Specify Require mwnn) ' <br /> / `'-------------------------------------------- ~ —_—. ---------- <br /> ---- <br /> - ` <br /> v''' 'JDraw existing And Aruire� aj i n freverse side) <br /> -'--'—'' '�-' '----'- <br /> � ��wp ���� <br /> I hereby certify that I have pr�parecl this application and that the work will be done in accordance with Son Joaquin <br /> County Ordinances, State Laws', and Rules and Regulations of the San Joaquin Local Health Disteict. Home owner or licen- <br /> sed agents signature certifies t6 following: 9 i <br /> > dition or, <br /> certi' -- - -- ------'- d' --' -- --' -' -a-- in -ch manner <br /> as to b <br /> ^ Sig Owner <br /> . By ---------------------------------------- -�- Title --------------'----'--' <br /> (|fo*he, H`onuvvned <br /> FOR DEPARTMENT USE ONLY <br /> 'APPLICATION ACCEPTEDBY -------'''-- `r---�r---'-------------'-'--'- DATE __7_-_---7 <br /> 8U|U}|NQ PERMIT ISSUED ----------------------------------------------------- ----------------------------------------------------- ------------------------------------------- <br /> ADDITIONAL <br /> __--_-_-__ADD|TlONAL COMMENTS -----------------------------------------------------------------------------------------------------------------------------------------------_-__ <br /> - z� _���' <br /> ------����--'--'---''7�r' '��-,`- -'- -''�z��c'���-------'--'--'------------'-- <br /> ���������'����_� ��_��"��_���_���----------------------------- <br /> --� ---� - -- ----- , ------------------------------------------ <br /> .---_----_- '���� -- <br /> Rno| |n,po�konby. ��- ���--��'/�L ----------_.---Dote --. <br /> ^ .SAN Jn^\�o/N LOCAL HEALTH 08TR|[7 <br /> E. H. 9 1''68 Rev. 5M, _ <br /> r^ . <br />