Laserfiche WebLink
L_��j <br /> R OFFICE USI:: APPLICATION FOR SANITA'I'!ON PERMIT <br /> Permit Na. .-•7- ' <br /> (Carnplete In Triplicate! <br /> ............. Porml#Expires l Year Prete Date 1ssaled <br /> This install the work heroin <br /> A Iicationas hereby made to the San Joaquin Local Health <br /> District for a permit to construct and and uhak he r <br /> pp mance with County Ordinance No. 549 and existing Rules a g . <br /> li2atio made in comp <br /> described. This app n is �' ,�Icro ..........CNSUS TRACT ......................... <br /> ATION .............,......_...... <br /> .Phone <br /> .108 ADDRESS/LDC �� c�.L� � • ... .:_... .,..... ..... <br /> Owner's Name ^� =..: ...City .. .............. .e16 6 �p <br /> AddFess ._.. - .=�."•` az .. .9..................License #' ..... . , .. .......:.. Phone •• <br /> Contractor's Name �`` ... u fc arratler Court <br /> ._..:._........ Commercial <br /> Residence UfApartment House{] <br /> installation wilt serve: . . .. ..: . 0. <br /> n. Motel Q Other......... .. ....... .. �f.'. :. .�.. ..... <br /> rindw ........ <br /> .... LaR <br /> Number of living units:..._ ...... Number of bedroomsSim <br /> -.....Garbage G ..„:......„ • :,.--••,..•„-.:,--.••.Prirram <br /> fWater Supply: public System and name ::..... ... . It•-- ••Clay•0.•--peat 0. Sandy Loam 43 Clay'O m <br /> Character of toll to a depth of 3 feet: Sand T] ..if .:.•. <br /> Hardpan o Adobe E Fill Moterlal ..._. hPf.• ' <br /> E ,. _ . <br /> i <br /> ` location,of s stem in �elatton to wells. buildings, etc. must ba Ply on rbr°rte } <br /> ' r r elder is available within 200.feet l <br /> (Plot plan, showing size of 'lot, locatlo Y , <br /> 4 <br /> NEW INSTAi.LATION• (No septic tank or seepage Pit permitted Pub .s ,- ri-�,,.. ..• <br /> pACKAGI:'{R£AYMENT .i SEPTIC'TANK' �s�_ - � . No. Compal .... ..... <br /> F pity l -Q-{7.... Type n :, °=u............... <br /> . Material' �.Q.`....... .. Q <br /> I - fl Lance.to nearest: Wall ... . .J•.•••-•• ••• ..” foundation Tato! 'Ler tl '0 •'ib' <br /> Length of lirte. .g�? ��� er ... . <br /> t LEACHING LINE No. of Lines - . :Qe`p Fits kd .... .V............ ....... . .. <br /> �p• Filter vial <br /> ype ter M Pr rty Line ............ ...........I <br /> -- .. <br /> y r -t Tdu on _.. .._ .... <br /> G Distance to nearest; Well �:• i _ - Ra*Flfled Yes No Cr <br /> /.:a.-.`. -• o re ....... rltJ[Ift�eF ....._.:. t ;�... . <br /> SEEP <br /> AGi; [)tL Depth r. ..:..:.......Rock <br /> 9r�+� Water Table Depth ..: ?. .. :......:.h... ..... .�. O Lilts .......1. ........... <br /> I .�.?.© -... ...----•...Foundation' ... <br /> Distance to nearest: <br /> Well <br /> e 1 .... , -} <br /> REpAi1t/A�ITION#Prey Sanitation Permit 91E ..... :. :.. .. Date :-Y :-+ -- ...... ... .. <br /> Septic T <br /> ank #Specify Requirements).---:....... ... .. -..... ...................:.J..:...... . <br /> ...T..... ............... ...... . -..._.__......__. <br /> Disposal field !Specify Requirements! :......... ........... �........... ...................................- . <br /> -----••---- •------ ......................--••••�--••---...... j <br /> 1Draw existin and to uired addition on reverse side) tiin <br /> l hereb certify that I have prepared this application and that the work.wlll be done in.accordance,wi#h � �aq <br /> y <br /> County Ordinances, State Laws, and Rules and Regulations a! the'5arr .foaquln Lacat H�fi,_Dls#r�ct.Herne 4wr►nfr or liatt� <br /> sed.agents signature certifies the following: a Man In so&mamw <br /> f "i cortify that in the performance of the work for which this pervat is,issued, 1 shall not.emp oy 9y Pe <br /> as to become suble a Workman's Conn ensa#ion we o! Califernia:' <br /> p ---- - Ovvn@r - <br /> 1 la �` s <br /> Signed! Ry _.:. --•- ._.. ... . .. <br /> ..._....... �itie <br /> fY ............... <br /> (If other than own@r) � <br /> FOR DiEPARTMlTI USE ONLY ' c-} <br /> ........... DATE .c=a!-c1� ._... <br /> r• <br /> APPLICATION ACCEPTED BY --------- ---------- .......I. ...... _....__ ..._._...._.._:.DATE'::---..:...__:.._........_......_.__....._. <br /> BUDDING PERMIT ISSUED -_------- •....... <br /> ADDITIONALCOMMENTS ................ ----------••--.._......------•------.....--•...._..__...._.. ................... ...-. .... <br /> E _.. .....----•-. --•................ ... �__�� _ - _ .._......_. . ...._...... --••--- ...._..---:..__.........--- :.. <br /> E __— ` .._... <br /> ................................... <br /> ... Date <br /> ........ ........ . <br /> E final Inspection by: ............... • -••--.....----------•------------ 8/7h 3M <br /> =_ EH"13 2h •1.-68 Rev. -5H ,� �• SAN JOA(Wii�= LOCAL_HEALTH!�D RICT <br />