Laserfiche WebLink
' <br /> FOR DFf|CE USE; ' � ' ` <br />[ USE- <br /> APPLICATION FOR SANITATION PERMIT <br /> (Cwmp|oe in Triplicate) <br />� Issued--- <br /> This Permit Expires 1 Year From Date Issued <br />� <br /> Application is hereby made to-the San Joaquin ^ <br /> Local Heo|H` District o permit <br /> construct and |n,^install /hu work herein described. <br />' <br /> This opp|icohnnismade incompliance vvitCounty�Or6inonceNo. J4q�n6exioth? Ru|�sondRpgv|oMon,. <br /> . . �^. <br /> V <br />� _ <br /> Owner's Name...- -----------. /,� -----CENSUS� ..`'...----------' <br /> / <br />|� <br /> Contractor's mome' .�°���V��'����� ��k''� ---------- ''' .. ..Liconsw # 21 phone � ' <br />| <br /> Installation will serve. ResidenceApartment House El Commercial F-1 Trailer Court E] ` <br /> Motel <br /> . ^^ � � <br /> Number ofliving units —`x.—_.�Nunn6erofbedruomo����--Garbage Grinder .Lot Size------ ---''- ................... ' <br /> Water Supply: Public and name-- ^ ' <br /> ''� �------------ ��----------------- ........... ---- ------- —,---`Private <br />� <br /> Character ofsoil toodepth of 3feet: Sand Silt [] C1uyE) puat [] Sandy L <br /> 'oom . Clay Loam [] ' <br />. ' Hardpan A6o6ntK Fill Material .... .... fyes, type................... <br /> -- ---� <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br />� <br /> PACKAGE TREATMENT [ l SEPTIC TANK { ] �` Size-- .............---.��--------..Liquid Depth..��.���------^�� <br />| <br /> Capacity---—` . ..........Type-------------- 4—.Mote-rioL--------.:.'No Compartments.................................—Zv <br /> ! <br /> ` <br /> Distance nznearest: VYeU.:........-------`—........ Foundation............ — —Prop. Line.............. ---Q�^� <br />� <br /> LEACHING UNE [ } No. of Lines... ------------_------- of each line <br /> — — Totu| Length — �-------`~�� <br /> .U' <br /> Box-..-. _. -Type Filter Muher|oL-----' Depth Filter Material <br /> —' --------------- .......................... ------ -- ------ ........ ------------- ----------- --------------------- —...... ------------------------------------------------- <br /> (D/u*° eximing and nequ|n»6 addition on reverse side) <br /> | hereby certify that ; have prepared this mpp||*aHmn and that the vvm,k will be done in accordance with Sun Joaquin County � <br /> Ordinances, Shote Laws, and Rules and Regulations of the Son Joaquin Local Health District. Home owner or licensed agents ' <br /> signature certifies the &w0mvrng: ' <br /> ^| *w,Mfy that /n the performance of the work for which this permit is issued, | shall not employ any pmromo in such manner as <br /> to become subject to VVCalifornia." <br /> Signed-----. <br /> ­/......... .. ...... .........Owner <br /> By............ -----TiMe------------------------� <br /> v, wxvr than uvvnenYOR DEPARTMENT USE ONLY <br /> ,�' ` <br /> ' <br /> � <br /> APPLICAT|QNDAT �—— <br /> --------- -- ^--~. .---^~----- � <br /> DIVISION OP -----'—____---.-----------------DATE---------------- <br /> ADDITIONAL [O�Ak�ENTS—x� �..................— <br /> � <br /> --------------- ------- —................. ------------ -- ........ r-------------- ^----------------------------' / <br /> ----------- - ----------------- ----------------------- .' ...................- ------------- .^.--- -------- ---------------------- -------- <br /> -------. � <br /> --'---':---' —~--------' ------------'----'z�--'------' ' --- ------ <br /> � <br /> Rno|'|ns�p*cnon _—._----__..-----'--'-�-,_'---.-------.Date---k � /- ------- ! <br /> ,o /u m 4��\ ` <br /> SAN JOAQU|N LOCAL HEALTH DISTRICT F&S 21677 REV, 7/76 3M <br />