Laserfiche WebLink
N� <br /> FOR OFFICE USE: <br /> FOR OFFICE USE: <br /> APPLICATION FOR SANITATIOW ERMIT <br /> Permit N - <br /> -------------------------------- --------------- (Complete in Triplicate) <br /> -------------- ------- -- Date issued_.-- -------- - <br /> This Permit Expires I Year From Date Issued <br /> 11 the work herein described, <br /> San Loca l <br /> the I Health District for a permit to''construct and insta <br /> Applicationlis hereby made to and,existirjg Rules and'Regulations: <br /> This application is made in compliance with County Ordinance No. 549 <br /> -----CENSUS TRACT----- ------- ---------- <br /> VON/ ---------------- ------- - <br /> -------------------- <br /> JOB ADDRESS/LOC ---- --- -------- <br /> 0�z <br /> ' , i --- -------------------- -------------Phon77?10 <br /> ---------- <br /> z!�Z:s; ............ ... <br /> A ----- -00- <br /> Owner's Name... ------- <br /> - -----n_. `-,City. -- ----Address------- -------------------;___ • -----------w.--- <br /> Phone---------------------------------- <br /> -------License. <br /> Contractor's Name------ --- --- ------------ -----------------W-------- <br /> C <br /> Residence E] Apartment House.F] I ommercial Trailer Court D <br /> Installation se-rve.. <br /> Motel-[1] ----- ------------ <br /> Number of living units ae!;-------Number of bedrooms ------------G.arbage Grinder------ __Lot ---------------- <br /> --------- ------------------Private <br /> Water Supply: Public System and . V <br /> ci�-Loam Clay Loa <br /> Sand E] Silt El -Cloy Ej Pe Son <br /> Character of soil to a depth of 3 feet: <br /> Hcsrjp—an 0_KdZCeff_F F11—ga—ter—ial =._ I�X_yes�,_type------------------------------ <br /> >. <br /> -- --�>"�_ IM' dit.156---place�d'-_-bn,rev—ers-Ze'�si-d�'.) <br /> m in relation to wells, building's, etc. side <br /> .l <br /> plan, showing size.of lot, location of system <br /> ad if UL I i s 6we'rLI-s.-a'va i I a�I e within 0-0 fe ei�,'j <br /> I (No sep!ic tank or seepage -pit permitti <br /> NEW INSTALLATION:' N -- 'Liquid Depth. --- <br /> -TA-RK— --------------7----- - <br /> PACKAGE T <br /> I ----No. <br /> Dom. <br /> --- Co�npartments._____,---------- <br /> apacitg�o -Ty ---------- <br /> C <br /> s. stance-to nearest: We b 6 Xiad t '-FoAdat6_ --------------Prop. Line-A ------- <br /> un <br /> .21:__ _Total Leingth�__-__------------ ------------ <br /> 7LIACHING LINE Nz.­of- ines.--- -------- 6t of e -------------- <br /> _t_De�ik'Filter Material --- -------- <br /> Type Filter 1 - -- --Box- _- Mater - <br /> ------------- <br /> -1-tind----/0 <br /> jo>( too nearest: I __,—._Foundation__A ........ ------Property ——:Distance n st: Wei <br /> Rock_F' Illecl YeSO POCA, <br /> SEEPAGE PIT Depth---- ------------Diameter---------------- ----Number--------------------------------- <br /> s", -------------- 4E. <br /> ter Table Depth---:---------------------------------- -------------------Rock Size---t- -------- <br /> Win <br /> ----------------- <br /> 77 Line - <br /> Distance to nearest.. Well*_-'------------------- -------------Foundation------- Prop: <br /> _-A --------- <br /> REkIR/ADDITION (Prev. Sanitation Permit#--------------------------------- --;-- ---------Date__4----- --------------- ------- <br /> "ta <br /> Septic Tank (Specify Requirements)--- -------------------- --- ---------- --------------------- - ------ -- ---------- ----------- ---------- ------ -------------- C <br /> ---------------------- !L <br /> Disposal Field (Specify Requirements)------ ---------- -------------------------------------------------------------------- <br /> - -------------------- <br /> --- ----------------------- ----- ---- ------------ <br /> -------------------------- ----------- - -------------------------------- <br /> ----------- -------------------------------------- <br /> - 1- ------------ ---------- <br /> --------------------------- --------------------- ---------- ---------------------------------------- ------------------- 4. <br /> ------------------- ----------- ------------- <br /> (Draw existing and required addition on reverse side) <br /> ccardan with Joaquin COV�ty <br /> 4 ill be done in a 11 , San jouqq <br /> I hereby certify that I have prepared this appi.icatiomand that the will Home n&r <br /> San Joaquin Local Health District. H e ow' ! or licensed:agents <br /> Ordinances, State Laws, and Rules and Regulations of.the; j <br /> signature certifies the following: SS' [A rson in such mangier ax <br /> k for which this is I shall not empl6y any pe <br /> 1 certify that e performance of the war permit issued, <br /> 7 <br /> s Compensation laws of California." <br /> to become//su ieAf-4k). - - -------:Owner <br /> Signe -- ------ <br /> t <br /> -------------- <br /> Title--- ------ -- -------------I------------------ <br /> ----- ------- <br /> ------------------------------ <br /> By------------------------------------------------ ------------ <br /> (if other than�owner) <br /> MENU � <br /> FOR DEPART USE ONLY <br /> 11 j ------------------ <br /> ----------------------DATE. ---'- -- ---- ------ <br /> APPLICATION ACCEPTED 3 DATE.------ ---------------------- --------- <br /> ........ ... ..... ---------- -------------------- --------- --------- <br /> - -- ------- <br /> ��ER ----------- <br /> XV�jlSbN OF LAND NUMBER�.. --------------------- --------- ------- <br /> -------------- ------- <br /> - ----- ------------ -------- -------- ---- ----------------------- <br /> ADDITIONAL COMMENTS. ----------------------- - ------------------------------------- <br /> ------------ ----------- ----------------------- --------------------- <br /> ------------- ----- <br /> ------------------- --:------ ----------------------- --------- <br /> - --------------------- ----------------------------------- ---------------------- ------------------------------------ ------ <br /> -------------- --- -------- ------------------------- -------------------------- ----------------------- <br /> -------- -- -------- ------------ <br /> --- <br /> ---------------------------------- <br /> - <br /> ---Date <br /> -- - - - -------------- <br /> Fin6l Inspection by:___ F&S 21677 REV, 7/76 3M <br /> Eli 13 24 N JOAQUIN LOCAL HEALTH DISTRICT <br />