Laserfiche WebLink
FOR OFFICE USE: <br /> APPLICATION FOR SANITATION Is <br /> ete In Triplicate?ii G <br /> p tate? Permit No. ...7......... <br /> This Permit Expires 1 Year*MDelle Issew Date Issued ../-'2 F-74 <br /> Application is hereby made to the San Joaquin Local Health bistrict for a <br /> } described. This application is made in comp3iartce with Coon permit to eonOrsiet and indal! the waprlL herein <br /> f/ ty Ordinance No. 549 and existing Ruler and Requletbsssr <br /> JQB ADDRf:SS/LOCA ON :,lie�}y� <br /> Owner's Name `.lam ;7�-sem' ' �'. ... ......: ..................... TRACT ..... ».... <br /> Address �; .. -,J� ...........:................... ...... ..<. : .. ......phare .. ... .. ... .................... <br /> Contractor's Name ' �]�� <br /> �y <br /> . ... :....lio.n5e .s�c?X Sty3 <br /> Installation will serve: •--..-.:?n,.. "fau. <br /> Residence l�Apartmem H . •"' <br /> Dose❑Commercial❑Traller Court ❑ <br /> MOM other <br /> ......._....... <br /> Number of living units:.. .... N ................... <br /> .. umber of bedrooms .._.Y Gar6ags Grinder <br /> Water Supply: Public System and name Lot text .. -? --� :... _.. <br /> us Character of 5011 to a depth of 3 feet: Sand❑ Silt❑....q ................... <br /> y..........per �.................... ..............PMvate i <br /> Pan❑ Adobe ❑ Sandy Loam� G1w Laron <br /> Hard ❑ Fill Mot eels?............It yes,type„ 10 <br /> .. <br /> ,• (Plot plan, showing size of lot, location of system In relation to wales, buildings. <br />' NEW INSTALLATION: etc. must be placed ort ►ever>te.e1dA) <br /> IND septic tank or seepage pit <br /> PACKAGE TREATA�ENTpe^mi"edIf public "war Is avoi,aet,} <br /> ble within ZOO fe <br /> . [ ) SEPTIC TANK(J Sim 7 <br /> CapoN ly .................... Type .. Material...•.'.............. No. Com ......................:J�' i <br /> oi5ron� ro nearest: Well pdrtenonts ............ ..x <br /> a. LEACHING LINE [ j No. of Lines ..... .... ...............Foundation.......,.............. Prop. Gree...:........... Jr <br /> D .......... Length of each line... . Total length Jt <br /> 4 Box • .......... Type Filter Materia! ...................:Depth Filler..,..:.. ..........». <br /> Distance to nearest, Well <br /> teriol ........:..................... ....... <br /> ...: <br /> s SEEPA p Foundation r <br /> GE PIT [ ) De Depth - <br /> ft+ Diameter ................»... <br /> ................... ..... Number <br /> Ire <br /> Rock Filled <br /> Water Table Depth .................:... Ye: ❑ No <br /> Y". Distance to nearest, Well Rork 51><e...........:................. <br /> ;y REPAI1t/ADD,T,ON(Prov. Sanitation Permit ....... ..Foundation ................. F". Line ................... . <br /> Septic Tank <br /> ......................... .... .. Date ..........:................... <br /> (Specify Requirements) ••I <br /> Disposal Field ISpecify Requirements) ... -eC.l .. �t — » _. � <br /> .... <br /> ............... <br /> a i�aw existing..... ............. ............ ... .....,........ ................................. .......:... ... <br /> andr auired ................................._..................._.... . <br /> r_ , hereby tersely that I have rt eq addition on reverse side) <br /> prepared this application and Heat Nsa work wl1l <br /> County Ordinances, State Laws, 0"d Rules and R u,atisn:of the Saar be done In -tee no" wills San :. <br />` sed agenh signature tertlfles f loagWn Late, H <br /> he fallowing: ealth Dlststet.Nssne esvreer or Dom"1 certify that in the perfermante of the work for which this permit is issued, I shall not employos M b#c6me subject to Workman's Compensation lows of Colifesn,a" any person in such +netestet <br /> Signed—, - <br /> B /. <br /> y . .. ... .. ..... Owner <br /> (if 0th r th Jitle "' 4-t_ <br /> e an owner} - ' . <br /> K} FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY . Q. ; <br /> ADDITIONAL NG PERMIT ISSUED DATE14 ` ../� <br /> 4 <br /> COMMENTS . . <br /> ..............:.:........................,...............:........DATE .r. .�........�.... .. . <br /> 41 <br /> C Inspection by: .... L.:. ................... ............ <br /> j IOi 13 24 1-613 Nov. r .�s �OA base f ����..." .... ..�.�.... <br /> �j QUIN LOCAL HEALTH DISTRICT /7 i <br /> ' i <br />