Laserfiche WebLink
FOR OFFICE USE <br /> APPLICATION FOR SANITATION PERMIT ° , <br /> (Complete In Tripitcdle) ermit No t+ <br /> s � <br /> _. This Permit Expires t Year From Dots lswed <br /> !Sy <br /> App(Fcation'is hereby made to the Son Jocquin Local Health D s'rict for 'a per nit +o`'cc-struct anN intta� :! rain �m <br /> described. This application is made in with Count, Ordinance No 549 an ' ex.stl 9 Rules aridili9Ult�?t r <br /> 2 Jog A�)c)RESsr.. ATION <br /> �PK.F.. Phon <br /> r Cnxn e r s Fame 1V•�. ,�- .... ... 1 , <br /> Address .. . l / 9.5...:., 1 .. lP� .. <br /> Phone <br /> Contra t r s Nod C, :. .. : se.. .. <br /> lrstol!ation will serve: ResidenceApart^ent House {orri�eradl Trai,er Court, , s <br /> . / r <br /> ' Motel ❑Other <br /> Number of Ilvirg unit Number of bedrooms .�-�...Garboge Grind r ��-_ i.ot Size <br /> r <br /> Water 5 o v: Puc; c System and name _... .. .. . .. <br /> - , <br /> Cr.oracter of so,!to a depth of 3 feet: Sand Q Slit Clay Q i Peat Sandy Loam 'aV <br /> Hardpan ❑ <br /> Adobe `i Fili�'Mnterial '1. . 9f yP,, type <br /> a <br /> >zv J 'De i <br /> Plot tanowing t"ze of lot, location e system in relation, ells, buii .n s, e+ mustint�!! a a <br /> ON: (No septic tank or seepage pit permitted if public sewdr is av aoie wit - eon) f <br /> TI <br /> N4�Kl� tTREATMENT j 'SEPTIC TANK ] Siie } Liquid <br /> Material <br /> � <br /> �tNo Com <br /> pde <br /> Capacity . Type � Foundation <br /> rt <br /> Distance to nPorest' `tiell <br /> roi>vt� , <br /> F _. I _ To al en f <br /> LEACHING L, 1 No. a L nes f!f LL�e��th;of t7dchil�re-_. =' <br /> tfi? tir�' -D' Box t Typ��F Iter Mdlerial` ..... .Depth Fill'er `1a4erta� , <br /> starcr to e rrc,2:'��/ell Foundation ProiSefty Line <br /> Dl :K �❑ Na <br /> �.. Rock Fi lad 1�e: y �: <br /> S;=EPA�•" PIT (" Depths t Y1!1 �1gr 'er NVmbq f` rfi 'e <br /> WdterZ TaYala fJep, .... Pock Size <br /> 1 <br /> FoundationProp Linsr <br /> a REPAIR ADDITION jPte Sant r Fres.: ✓eY <br /> Drstan�e P <br /> .r t.' 1 f I ... ._ Datef"yaf„, t <br /> errni # . ova <br /> >' <br /> Septic Tank (Spec ke quirilCrQ9ts) - <br /> 1 <br /> . r <br /> f• Req' rer,,eh, ) ..-....D1.S`fQY: •� 7�f5 L/ilf <br /> D',sp.,s- field (S f� ✓ r <br /> nl F t�ACF�_ La.N ... ..a > <br /> s, <br /> (Ljraw existing and required addition cr re erre"side) } y u, viA' <br /> I hereby certify that I have prepared this application and that the work will b�"don*�in atcordanto wthStsn sQ <br /> County Ordinances, State Laws, and Rules and Regulations of the Sar, Joaquin local Hlplth_Districf^Hom� ! `ak��h' <br /> j dC " S t�¥ tis1t#1 t r <br /> sed agents signature certifies the following: <br /> f erformance of the work for which this permit is issued, I %hall'not,}sts loy any penon'in •ueh�ntann <br /> y ,I certify that in the p <br /> ry <br /> as to beco. a subject to Workman's Compensation laws of Ca'i'ifarnia." �� �t,3 tea � � <br /> S;9 <br /> ( d7 ✓i'rs. . .� rG ....-.... Ca Ij)r xr Lae tT; <br /> 9 , <br /> S ��% Title <br /> r t owne,' <br /> FOR DEPARTMENT USE ONLY r <br /> .... ,,,,; °'ED By <br /> BATE <br /> HP��ICvi �r <br /> __ 6 <br /> l_DING" ERNiiT"i55U 1 \ z " v t.' <br /> -,DD IT ON,= CO h7l <br /> _.I�1.0 ` <br /> SAN JOAQUIN LCCr,_ <br /> �.r� <br />