Laserfiche WebLink
J <br /> FOR. f?FFICE U«: ,k.sFU.L,T1GN FOR SANITATION PERMIT <br /> Permit No. <br /> NL mplew In Triplkele) <br /> Date Issued ?.1..7 <br /> remit Expires i Year From Dow Issued <br /> F Application is her�1)v mn �' p Son !ojquin loco! Health District fer a permit to construct and Install the wokt <br /> 111WO <br /> described. This `^ .s vain :n compliance with County OrdinanceNo. 5+19 and existing Rules and "10110M <br /> JOB ADDRESS/LOCATioN X 5 3..G.2..... .: .... '3�.. •'... ................... ...........».... ...» <br /> Owner's Name ���.:!.L/���� C' ............ �.......PI1oM . .. <br /> Address /;^(: . �� '��JJ�. ...l�e.e }' . ............City . d .. ......... .. ........................... .._» <br /> Contractor's Name JL <br /> lc.C. . ��G�. . . ..../ ..... .....f ............License# .1�c i� + �"... PhaM ...............»............. L <br /> Installation will servo: Residence[Apartment House J3 Commercial❑Troller Court fl <br /> Motel❑Other.... ... \ <br /> t" <br /> Number of living unitl: /.... Number of bedrooms ...........Gaboge Grinder ••••........Lot IMze <br /> Water Supply: Public System and name ................................... ..............r.......» ».»». ......»...»Prhraw <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Gay C3 Peat C3 Sandy loam Clay Doan 13 <br /> Hardpan❑ Adobe❑ Fill Matwlol ............K yes,type».........»..».»..»... <br /> b (PlotP Ian, showing size of lot, location of system fn relation to wells, buildings, etc. must be pboed as re" M sidel� <br /> NEW INSTALLATION: (No septic tank or ;gage pit pwmW*d if public s&wis avgllaWe wM 9n 2Wfeet') <br /> Size...?.:».c .l......� ..5............... liquid Depth, ....................� <br /> PACKAGE TREATMENT [ ] SEPTIC`�TA�NK <br /> Capacity ./ c�...... Type 4 AAahWl1d1... 0emp01111WOI <br /> Distance to noorest, We!I ..r �'. ..........»...Foundation...../.G ...Ftop.LIMLEACHING LINE [tf No. of Lines .... .,,3............ length of each IIM....�.�.......... Tow Length'D' Box ... 1....... Type Flltw Material ....5.R........Depth Filter Mah►o .... '......... .Distance to neonst� Well ......1�P.. ".... Foundation ....Jl1 `...... Property LIM ..SEEPAGE PIT [t� Depth . . 4.6�. Diameter ....� . "' Number .. .... ... .F�Rodc Filled Yes NWater Table Depth ............. ..lL?�t: ....»_..Rock Size Distance to nearesh Well ...... .........»...Foundotlon ../. ».. Prop. lk►e <br /> Date ........ . .... 4 i <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ �= <br /> SepticTank (Specify Requirements) ......................................... ..............................»...._..................._............................. <br /> Disposal Field (Specify Requirements) ...................... ...................................................... . <br /> ....................................................................................................................... <br /> .._....».........................................._.... <br /> (Draw existing and required addition on revers$ido) p. <br /> I hereby certify that I have prepared this applical and that *A work will be deme M eveorderAs wMh fou mss <br /> County Ordinances, State Laws, and Rules and Regulations of tbo Sam .1o" ie Looe! MeaMb Dlsirld.Meuse Wow K low <br /> s sed agents signature certifies the following: <br /> "1 certify that in the performance of the work for which this 1110m <br /> it is 161140d, I shah ttet em P%y My perseu M strslt tstatster <br /> as to become subject to Workman's Compensation laws of Callfentle." <br /> Signed .Owner <br /> g <br /> / ��t,�' . .............. 7ftle . ....... .................. .......... <br /> By..... ...........................e�QU.i... ... <br /> Ilf other than owner) <br /> R DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ...0 DATE 3• " " """"""""' " <br /> -...... <br /> ........................................................... <br /> BUILDINGPERMIT ISSUED . . ..............................0.1.......................I.......................................DATE . ....................................... <br /> ADDITIONALCOMMENTS .. .. ..... ....... .............................................._................................................. .... .................................... <br /> ............................ .... I................ ................................................................ ......................... ...... ......................... .................. <br /> _.... <br /> ............................... <br /> ....... <br /> ...:.... <br /> .. ...........:_..... ......:........................................ ............... ...................:­.........paie.....: '2 '#..171................ .. <br /> 6 <br /> FinalInspection by: ....L ............................................................................... <br /> EH 13 2h 1-68 Itev. 5M0 0 SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3H <br /> `5 <br />