Laserfiche WebLink
FOR OFF CE USE: <br /> � <br /> ra APPLICATIOWFOR SANITATION PERMIT-- -------- <br /> ,h (Complete in Triplicate} Permit No. <br /> This Permit Expires 1 Year From Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATIO /a--Z_- -- !--- -- -1 - ---- --.CENSUS TRACT -------------------------- <br /> Owner's Name ------------ -- - ------- --- - ----------- ----- -------------------- --- - - ----- - - - <br /> Phone ------------------------------------ <br /> { <br /> --- <br /> Address !1 ----- ----2/'----- ------------------------------- Cit ' ' ------------------ <br /> Contractor's Name ..... ....._ -- -----------------------------License #O�S1J. _-- Phone A✓4�--j`�L <br /> Installation will serve: ResidenceXApartment House❑ Commercial ❑Trailer Court ;❑ <br /> Motel ❑ Other -------------------------------------------- <br /> Number of living units:--- Number of bedrooms -.�----Garbage Grinder ------------ Lot Size _034'040P ` ------------ <br /> Water Supply: Public System and name ------------------------------------ --- --------------------------------------------------------------------Private <br /> Character of soil to a depth of 3 feet: Sand'0 Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam$' <br /> Hardpan ❑ Adobe ❑ Fill Material ------------ If yes, type ---------------------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) G <br /> PACKAGE TREATMENT { ] SEPTIC TANK Size_ G�_� 5.. _� <br /> - --------- liquid Depth .___ _-------- ----- S <br /> Capacity ! �-O_-__- Type _ _- Material ---- No. Compartments --_-- --___�__ 2 <br /> Distance to nearest: Well ----S_�!)-------------------------Foundation __---------- Prop. Line <br /> LEACHING LINE [ No. of Lines -------f-------------- Length of each line___10-Q_ ------ Total Length .-Ad_G-•---------- a <br /> 'D' Box ------------ Type Filter Material S! Gt Depth Filter Material ____—/e— <br />