|
FOR OFFICE USE
<br /> APPLICATION FOR SANITATION PERMIT
<br /> (Complete In Triplicate) Permit No.
<br /> This Fermit Expi es 1 Year From Date Issued Dote Issued ./,.' •:_��
<br /> Application is hereby mode to the Son Joaquin Local Health District for a permit to construct and Instal) the war# F•neis {
<br /> described. Th:s application is made in compliance with County Ordinance No. 549 and existing Rules ael_ nd a
<br /> ResNlo las,
<br /> JOB ADDRESSAOCATI N % -
<br /> Ownei O �� l .srst.:..F s9,a.,�,�.t iI�*y ...., CENSUS lTRACT
<br /> Owner's Name .���T/9/' .. '� )��" .....�......... .....
<br /> Address J.7�. 9 >� '— .......................... ... ................. ......Phots..... ..... . ..
<br /> Contractor's Name /rtG►-..,.. t Clty ',�s+ .,................ ................
<br /> Lkonso!
<br /> ❑ .. .court . . Phots f
<br /> installot�on will serve . ....•....••....------•
<br /> Residences Apartment Nouse Commercial ❑ �
<br /> Morel O Other
<br /> Number of living un'ts f Number of oedrooms ..,x......00,bcp x
<br /> Grinder
<br /> Water Supply; Public System and name
<br /> Character of soil to a depth of 3 feet: Sond Sil . .... . �`..........................................
<br /> ❑ ❑ CI ay Pelh ~�
<br /> [) 3andy Loom m Cloy loan❑
<br /> Ho+dpon I'.;obe 0 Fill Mctsrlal . . If yes,hype.. ...... ... ..
<br /> (plot plan, showing size of lot. Iocat;nn of system, In relation to wells, build)
<br /> NEW INSTALLATION: INo septic tank or tee a e ft mss. �� til � �� � ��~ �' v
<br /> P g p permitted If public sewer is avalloble within 200 Isoj
<br /> PACKAGE TREATMENT SEPTIC TANKS 3ile /�t �� ' t S'y • V
<br /> Liquid Depth ,0Y f.»...».
<br /> Capacity /W',, I Type r'�'''�Gr,s�..., Material.
<br /> Distance to nearest. Well Sd . .. Comp, mw
<br /> lih
<br /> lEA[HING(INE 00 No. of lines = . .... .. ... Foundation Q' _.. Prop'
<br /> Length ts.;r�"P".:'»."'«'•»�,»»,,,",,",,,
<br /> of each lits A"2I ♦3)TOtol LenRMt
<br /> 'D' BOX;+++ r Type Fill3r Material IP. , ,
<br /> r Depth Flher M~31 /pl,,..,,...... ,........M.....r. �`\/
<br /> distance to nearest; Well Aw 74F.... hund0lon /• • i •
<br /> SEEP ( I Depth ca•S T ftwty Line �............«..,,
<br /> Diameter 1�.7' •
<br /> f/\ ...... lutnlr• 3—. Rock Rlkd Y
<br /> Water NoWater �►a e�drh � �h "".
<br /> ••,, , "� ...... �
<br /> 01
<br /> Distance est(Prov. So Sd r Otian PNmlt
<br /> •
<br /> RE►AIR iADOMON(Pr / •�pSlOdd '.! «............
<br /> 1M
<br /> Sept'c Tank (Specify Requirements) I) ~ ........^.,».,«»....
<br /> Disposal Field ..»..., "..... f
<br /> (Sped/y Requirements) .. .. ..... ..
<br /> . ...... ... ......................,.,.......... .».
<br /> r
<br /> (Draw emitting and regwred addition en toverse side) ........,. ..'........... .....",
<br /> I hereby certify that I hove pre*e- We epPllcatlen and the, Mo vr" willbe done In oaetsleme wft (Mss
<br /> Cwnty Ordlnences, State Laws, wsd Rules and liegulb"ons of the fon ,leogetrt Lotol 14
<br /> 0
<br /> e1M Dlstrlet. Neuse ante.N
<br /> sed agents signotvre cNtlfles the following: Plow
<br /> `(
<br /> ,.I certify that In the Wo—onto of the work ler which►his pettMf is (sowed. 1 shall nal ens I sNs
<br /> as to become wltloct to WNkn/an•s CornPsnsoNen laws of Glifens{e." 'cue r pastas In seek tmetstset 1. t ::r
<br /> y ki
<br /> Signed 40-0f,Xf-,
<br /> Owner r.
<br /> (If other than owno•) 7►tle �;.
<br /> FOR DE►AR_TM/NT USII ONLY
<br /> APPLICATION ACCEPTED 3v T/�� • •. 1 OAT!��j�.".�j ��•
<br /> BUILDING PERMIT ISSUED DATE
<br /> ADDITIONAL COMMc•;.s
<br /> Final Inspection by, Dtih
<br /> ' J=DAQ'jI►+ LOCAL HEALTH DISTRICT
<br /> E 4 9 W"Rev. SM
<br />
|