Laserfiche WebLink
FOR OFFICE <br /> 8E. _ APPLICATION <br /> ^�~�~ ANp <br /> �Nw,�m�UON ��muR �zT� <br /> Per <br /> mi+i_N~�u�^,!'�{Id�`=�-5-'0 <br /> (Complete in Triplicate) « <br /> ��� �/�0 <br /> Do <br /> - ---- -'_ <br /> .�� <br /> truct v <br /> and install -� ' <br /> Application is hereby made to the San Joaquin Local Health District for a per'mit to cons, <br /> described. This application is made in compliance..with.County Ordinance No. 549 and existing Rules'a�� Re6'ulations. <br /> / — ^ � / <br /> � <br /> JOB ADDRESS/LOCATION ^������ ` � <br /> ----------------------------- '- <br /> ----------- <br /> Owner's /"== - ^~-~ ---== -'-_-.-_'-'-' | <br /> �7 ~� <br /> . ^'--1ioonms v� -'—,----' Phone --------'--' <br /> Contactors Nome -««�� '----' | <br /> Installation will serve: <br /> ^ -J�� �/���H� m�e�|��|�� <br /> ` Motel E]Other' ,7 _--'_--'_---'-''-'-' <br /> Nvmbo, of living units. I-- Nu Imb� of6nxomu - --.Gorbage Grinder <br /> ..-j'--*---- Lot Size . m �R* � ~4^= <br /> ---- <br /> C-\ <br /> -.' <br /> ! ` rnvon: <br /> Water Supply: Public System and nmn�e -'-----'----'- - Sandy Loom � �ay ��m _ ~' <br /> peat E] <br /> Silt <br /> Clay <br /> Character of soil to a depth of 3 feetl__.;� Sand'o <br /> Hardpan Adobe-E] Fill Material .. ... <br /> ^ <br /> If yes, <br /> placed on reverse side.) <br /> (plot plan, showing size of lot, location �_f system in relation- to-wells�uilc!A_Ofe"tc. must be <br /> to k -pc�, it permitted i!yublic sewer is available within 200 feetl <br /> NEW INSTALLATION- lNo septic n or ;eqp <br /> Size---��t X-Jo------X---- �/'-_ I <br /> PACKAGE TREATMENT SEPTIC TANK! , s Z—a' <br /> 0 Type 'POOR _D_ Material Cj <br /> -D' Box Type' Filter Materia e. -- <br /> n <br /> Distance �o'neonam. v" x --- ------------ Foundation__ <br /> ' |�d Yes <br /> SEEPAGE PIT � '' D|omvp`» �� e�er - . Num / <br /> Voter Tob|A Depth -^ '—~ —'--------------- --------Rock Size 7�------- <br /> Nr <br /> --------------- <br /> Distance <br /> --- <br /> -�_ <br /> Disuxnceto nearest. Ve _ —_-_-_--Foundo�on . ��-__ Prop Lne � <br /> Date --------------- <br /> Septic <br /> (Prev. oni�u��nPnrmi�v� _-- -------'_- --'—'= <br />� REPAIR/ADDITION- _--.__-_-'--_.---_-_—_---- <br /> � Sep�cTonk �pod{yRequi,mn,en�) --------------------_'^^/ <br /> Diopnon\ Field (Specify Requirements) ..-J1�V��,`--«���xx��r���x-.^^n.��.~`^�"°.~ ~-~------ <br /> � i A������� � �p <br /> � <br /> and required addition on-rev4se�sid&) <br /> (Draw existing <br /> 1 hereby certify that I have prepared this application and that the work will The done in accordance with San Joaquin <br /> i <br /> aquin-Local Health District. Home owner or licen- <br /> County Ordinances, ~~- -- <br /> sed agents signature certifies the following: <br /> '21 1 manner <br /> | " c: ~'x for �vhich this permit is issued, I shall not employ any person in such <br /> trit sin the perFo ance,�of the work 'laws of <br /> Signed� ' . -�������._ Title ------------------------ <br /> ' By --- -------------------------------- -------- --------------------- - <br /> (If other than owner) <br /> ' FOR DEPARTMENT USE ONLY <br /> -------------------APPLICATION ACCEPTED BY| <br /> ' 0]|Lo|mGrERxxn IouoEv <br /> ADDITIONAL COMMENTS - ------ 4A__ <br /> �--_--'' � uo`c --''=^--^-^----- <br /> Final <br /> -- <br /> | Gno| |nspac� —f -'-°-''t,��~^-~---`-- <br /> SAN ]OAC8J|N LOCAL HEALTH DISTRICT <br /> ' ~i <br />