Laserfiche WebLink
FOR OFFICE USE; <br /> (Complete in Triplicate) Permit No.. i-T--------3-q-- <br /> Da e <br /> Application is hereby rii6de.to the Son Joaquin Local Health Distlict fo"r a .permit to construct...end install the work herein <br /> !4C 9t and existing Rules and Regulations: <br /> JOB ADDRESS/LOC, 2 <br /> r, Ile <br /> Contractor's Name ce <br /> Installation will serve. Residence 1��Partment House-[] Commercial OTrailer C6urt M <br /> Character of soil to depth of 3 feet: <br /> Sand'E] Silt E] Clay at E] Sandy Loom [] Clay Loam[] <br /> (Plot plan, showing I'size of lot, location/�f'system in relation to wells, buildings, etc. riwst be placed on reverse side.) <br /> NEW INSTALLATION ' (No septic.tank or seepager Pit permitted if p6blic sewer is available within 200 feetJ <br /> TypeAla, <br /> -------------- <br /> 'D' Box Type Filter Material ----Depth Filter Material <br /> --------------------- <br /> LJ <br /> Septic Tank fSpecify Requirenien;s) <br /> ------------------ <br /> (Draw exisii-n--g- ­a__n_`J__r_e__q__u__ir__e_d addition on reverse side) <br /> I hereby certify that I have prepared this application,and that the work will be done in accordarlice with Son Joaquin <br /> County Ordinances, State Laws, ar�d Rules and Regulations of the San Joaquin Local Health District. Home own�r or licen- <br /> sed agents signature certifies the following: <br /> f the work for which this permit is issued, I shall not employ any p� <br /> "I certify that in the performance o erson 'in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Owner------------ <br /> (If other than o3,)ne <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY --------- --- <br /> --- <br /> ------------.—.--_--__-- .—'--'_—'—_.--._.----'-----''---------.-- <br /> ------.-----.—. ----- ---------._— —_.--'_--.. _---- <br /> --'U—`--'---- '— +' -x�,' . ' ^ �~� <br /> Fno no�ochzn6v ~ u�' —'-'' �'----'-- <br /> . . pvc �'. ---,� ----�c..�----- .���������-------_Doh, <br /> SAN JOAQU|N LCAL HEALTH DISTRCT <br />` EH. 9 1''d8 Rev. SkA <br />