Laserfiche WebLink
FOR OFFICCU-St.. APPLICATION FOR SANITATION PERMIT <br /> % (Complete in Triplicate) ,Permit No. <br /> I Date Issued <br /> Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein <br /> describ'ed. This application-fis-made-in-compliance-with-County, <br /> -P�dinance.,No. 54.9 and existing Rules and Regulations: <br /> Owner <br /> Addresis <br /> Installation will serve. Residence <br /> _]Apartment House f] Commercial�E]Trailer Court i <br /> Motel f-I Other <br /> Number of JiVing units;.... --- Number of bedrooms 19 Grinder Size -1 <br /> ply: Public-System and name ------- -------Private El <br /> Characier!of soil to a depth of 3 feet. Sarycl'Ej Silt <br /> C161 y [:1 Peat Sancl�, Co—oml[] Clay,Loam 21- <br /> -Ho rd:-7jF—Wcl <br /> (Plot plan, showing size of lot, location of system in r6lbtion to wells, buildings,4, �'ed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pi t .pe.rmitied if public sewer isii:ivailable within 20� feetj <br /> Septic Tank (Specify Requirements) -------- M------- <br /> Disposal. Field (Specify Requirements) ----------5,FF-FjqE1 ------Pl--T-- <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will be dome in accordance with Son Joaquin <br /> County' Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or ficen- <br /> sod cl!`gent�signature certifies the following- <br /> 1 ceftify?th t din e perFortrance of the work for which this p,4rmit is issued, I shall not employ any person in such mannor <br /> Si <br /> (if other than owner) <br /> FOR DEWTMENT USE ONLY <br /> EP- <br /> ADDITibNAL COMMENTS ------- <br /> Final In ctlon t <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> EH. 9 1'\68 Rev. 5M ` <br />