Laserfiche WebLink
FOR OFFICE USE: <br /> APPLICATION FOR SANITATiC- PERMIT <br /> (Complete in Triplicate) Permit No. . 7.�.:..IL.I <br /> This t°rtrrnit Expires 1 Year rrcnr Dcte issued <br /> Date Issued <br /> Applico•.on is here',y made to the San Joaquin Lr_ul Health Distric' fir a verm:t to construct and install the work hareir <br /> desrr&cd, fhts nopii_etion is made,:^ corn:'once with County Ordinance No. 549 and dxisting Rules and Regulations:' <br /> y%>, - ✓�CNE:7I\E I CENSUS TRACT . . 5 . . ...JOB ADDRESS'LOC=TION . . <br /> Owner's Name .r'r':�L l-,X' Phone _.. .... ... .......... . <br /> r•r - r• — -�E �_ �' <br /> Address .Z�� / ,"> J[. !L' .7 City L=�CFl LC �1 <br /> Contra'or's Name 0;VDER6RcyND (•1 T-1 Lt i ,'.!~7 License ?k Phene ......... <br /> Installation will serve:' R•_s•dence Apartment House[] Ccmmemni []Trailer Court [ <br /> Motel r-1 Other _.. . <br /> tv c' i9 C is <br /> Number of i,�ing units: Number of bedrooms -� . ..Garbage Gr,nder Lot Size - <br /> Vvater Supply Public Sy,tern and nam:. _ Private <br /> Charac'er of so-1 to a depth of 3 feet: Sand E Silt 0 Clay ,_j Pent Sandy Loam M— L_} <br /> Clay loam -� <br /> Harc.t�an VY Adobe t] Fill Material `�/o If yes, type <br /> (Plot showing sizc of lot, IOC(-,tian or system in relation to well>. b„_Idings, etc.Ymust be ploced on reverse side.) <br /> itEW INSTALLATION: INo s^ptic tank or seepage pit permitter) if public s^.%,cr is available within 200 feet,) k, <br /> PACKA��E TREATMENT ! i SEPTIC TANK( J Size , . Uq,,,id Depth <br /> Capacity ,Jpt Material No. Coma-t.tment. <br /> Distance to nearest. Well Fc.✓ndot;on Prop. line <br /> ;EACirl':C LINE [ 1 No. of l:ne:, Length of each line lotai length <br /> U Dox Typ Filter Material L cpth F,I cr Mater al <br /> D"'Ifinre to r.c:^resi: "Jell Foundatiun Property Linc n� <br /> ;EEP;.r 71 IT DL p; D;nr-,etcr Numbe• Rock Filled Yes ❑ No C <br /> Nater Table L)epih Rn;l. Size <br /> ;rrt°nc to ne::r st. 7 1 F- ndot�jn Prop. Line <br /> R!?AIR ADDITION iF'rcv- Sanirction ,�rrm,t# (� D° <: I <br /> R>qu:, •'nnnt:., Af_tL ✓! t';IG •cx <br /> -I_ rvd c clr,,on On <br /> . re erse sidel <br /> I hereby c,trtiry that I h-:r✓c prepared this application and that the works• 11 be done in acro-dance with San Joaquin <br /> Covnty. Orr-;nanccs, Slote Lcw's, and Rules end Regulations of the S,-In Joaq in Lesal Health District. Home owner or licen- <br /> sed aye-ts >t3��alum c.•tifies the following <br /> "I certify tlhuVtnrlormanc cf the work for whish T5is pr'r-n:t rs isturd• I shall nct employ any person in such manner <br /> r a�:,L ff sation laws of Califatrnic ; <br /> as to b carni subject Workma Compensation <br /> .�1 7 ft l <br /> 7 r <br /> rOR C"ePARTMENT IJSE ONLY <br /> DAIr 711 <br /> -- <br /> ►/ ✓ /7 7 _ <br /> r <br /> I <br /> 1 <br />