Laserfiche WebLink
^ � <br /> ' ` �N� ���0��� p*n�� No <br /> � _ APPLICATION ~/ <br /> / w / �� <br /> �"mm <br /> ���ioT� <br /> �icm�) \u <br /> Date su'ed - - 7.�.. <br /> -- d <br /> I This Y ��mvFrwm Date�Swa � <br /> � <br /> -- d install the work <br /> constructan <br /> � � � oJ |nLoc� Health � .5A9 and existing Rules and R - |o+kwnm <br /> Application is '--' �on \y made With Ordinance No. <br /> 6esoibe6� Thisap��u8- <br /> ^ <br /> , <br /> --------�EN�U� TRACT -----._'_- <br /> --------------- <br /> Installation will serve: Resiclence)&partment House[] Commercial:.E]Trcii ler Cou <br /> Number of living units:----- --- NUM6,er of bedrooms ------------ <br />� <br /> Water Supply. Public-System <br />� � �^ � M 0mat0 Sandy Loom -loy- <br /> Character of m \ to depth of3 {ea� Sond�� ,-� - <br /> ko] Myeu.��o ..------- <br /> Hardpan E] A6b6o� Fill Mated <br /> buildings., etc. must be placed on reverse side.) <br /> elation to wells, <br />/ (plot plan, showing *z" of '~'' location- p ` -- <br /> ~ � public <br /> sewer is <br /> m ^°" '`~'" <br /> U�o_�*pMc tank orseepage p0 nnau e�h ._ <br /> ____ <br /> ___^''-' <br /> ~~^ ---- SEPTIC S�� _ _ __------ Liquid D <br /> P' -- [ ] Compartments . <br /> Copoc�y --- Type ' � Material ---- <br /> ._ <br /> kN� Prop. U_n <br /> e <br /> '^----- <br /> F�un6otkon ---------------------- <br /> Distance <br /> '---- <br /> Di�once *, noureu�� Ve'| . ' ------_'_ Total Length ----------------------------- <br /> - <br /> ._____ <br /> --�—' Length of each Unm-'-'--' ------ <br /> LEACHING <br /> '- <br /> LEACHiNGUNE No of Lines --' -+' ial neoH� Filter Material ----------------' <br /> 'D/ Box ' Type � Property Lh�e '---'--'--' <br /> o/oxznce to '="r*o� Well ^ , ', ~ Foundation _ --- Filled Yes N" 0 <br /> � Number ----.----.- Rnck <br /> Depth ---_- <br /> Diameter <br /> StE [T <br /> ---------- Vat-e, To6|o ne`oth ' ''__'_-------_' <br /> _JRockSize -------------------------------- <br /> Distance to nearest; Well <br /> -'-------Distance +unoonavtVe \ -----------------------------------__Foundation -------------------- Prop Line -.-_.--- <br /> . " ~. Perm� � - Dpte _'--'-'-'-_'_'-] <br /> _- (Prev.rn�v o" ." _ _ <br /> .~ <br /> . <br /> Sep .` ='~ ~r--' ' ' <br /> � -',_- <br /> �-�- <br /> ___1---------------------------------------------------------------- <br /> - <br /> -_--_- <br /> . <br /> -.--'-_----_ ' � <br /> r- --____'_---- <br /> ---- � <br /> __--_. <br /> _-' <br /> '-'' ' '--''--'- side) <br /> .--�2-=5-- (Draw existing and mqu\ro6o�6h1�� cmn�vers- � Son Joaquin <br /> this application Ond" 'k will be done in accordance v <br /> ~8v � <br /> | �� ��� �� ' --'- ^ �n� �pm� �nd Regulations Of the Son Joaquin Local Health District. m�e owner or �mem <br /> �wwn� ordinances, State L*» y ~ <br /> ' � mon <br /> in such manner <br /> sed agents signature certifies the following: <br /> for w���� �6�w ��,mii is issued, V shall not �m� �w <br /> °U certify that in the performance of the work <br /> as to become subiect to Workman's Compensation laws of California." <br /> Owner <br /> . Title ----- ------------------ <br /> '-----T`- ^ / <br /> P-p-ea-�_ (Clf-other than owner) FOR DEPARTMENT USE ONLY <br /> ' <br /> APPLICATION' _____��� <br /> 8U\LD|NQPERMIT ISSUED .�.____.__ _ ____.______^_____ <br /> .__.--- _'--_----�� <br /> -------'-'---'- --------------------------------------------- <br /> ------------------------------------------------------------------------ -^r^'/ <br /> '--' by �J8/^�_ ' m =+_'-'___-' <br /> Final Inspection ' '-' HEALTH DISTRICT <br /> - -- <br /> SAN J<]A�V|N LOCAL w <br /> ` n w 9 l''68Rev. 5N\ ~ _ <br />