Laserfiche WebLink
- - <br /> � �� �������� ���� <br /> �/� �� � '- ' ~'~...,,~.. � <br /> ,� Permit 6 ~ <br /> ( �*mp/�minT�pOpmw� ^ <br /> \ � ��� <br /> � Do� |z�uo6 " ......' <br /> Th��e,�� hwv Ymm, - '- <br /> ' . <br /> ^ , <br /> Application is hereby made x,the Son Joaquin Local Health District for o permit to construct and install the work herein <br /> . <br /> described. This application is mo6a in compliance with County Ordinance No 549 and existing Rules and Regulations: <br /> - <br /> ]O8 ADDRESS/LOCATION -/1111_1�.-^ ------------ --.CENSUS TRACT --------.. <br /> , <br /> , Owner'x Nome ����� �� ����� P�n 5��- ���� <br /> - - ''�'~�~~-~^=,-`^`�°'"~°~°^-�-�-~'~~`--/-�' ' ' ` - ~ / -' --' <br /> Address -_-'----' -'----__-_-_-..-__. City - '--__-------- <br /> ` <br /> Contractor's Name ------ - ----------- ------------- ------License # � ���� '- Phone <br /> ' �Installation will oenm� Residence []Apartment House{] Commercial OT,oilenCourt 0 <br /> ' ~ <br /> Motel []Other ---------- ------- ------ -- .......... <br /> / <br /> Number of living units:----- ----- Number of 6a6rmom» '-Gprbage Grinder Lot Size ------ / <br /> ' Yxote, 3wppk^ Public System and name -------- --- ------------------- -------- -----------____....................... ----------Pdvote.1A <br /> ` <br /> Character ofsoil toudepth of3feet: SanJEj Silt E] Clay Peat E] Sandy Loam O Clay Loam.Ej <br /> � ' <br /> H�,Jpon [] Adobe piUN��noi If ��e - ^ <br /> ._ ", �n ---- . ------� -' <br /> � <br /> (Plot plan, showing size of !o� ' M�n of system |� n4u�on to we |� 6oi|6ing,' r�� must 6= p|ocr6 on reverse o��l <br /> . . <br /> / NIEW|NWTAKLATION: Uqu oop*/c tank or seepage pit permitted if public sewer i, available within 2D0feotj <br /> PACKAGE TREATMENT [ ] SEPTIC TANK Size Liquid Do[�� -------------------------- <br /> Capacity <br /> � .. <br /> ----------------' -------, <br /> ' Copocih/ i----�-. Typm -------' Material-.----....... No. Comportments --------' � <br /> D/monca to nearest: Well --------_-------------- -''Foundation .... ------------- Prop. Line <br /> LEACHING UNE [ 7 No of Lines -------- ------' ...... Length of 'each line---------------- Total Length --'- <br /> , 'D' Box Type Filter Material --------------------Depth Filter Nhzteho| -----___----------'-_- <br /> m,�mce to neo��. YVoU ------------ Foundation -------� Property Una' _'-_-'�^�� <br /> / "- <br /> SEEPAGE PIT [ } Depth --'- Diameter ---------------- Number ............................ Rock RUe6 yes No C] <br /> ` / <br /> ' Water Table Depth -_----_-____--RockSize ---------- <br /> � <br /> Distance tonearest: Well ----------------------------------------Foundation -------------------- Prop. Line . . <br /> (Prev. Sanitation Po,mh# -------------------------------------------- Dote ---------------------------------- <br /> Septic <br /> .--_--_--_'Dephc Tank (Specify Requirements) .................... -.---._-------- ---------------------------------------------------------------------------------------- ' <br /> ^+ , <br /> Diopnxo| Field (Specify Requirements) ' ' j ar/� - <br /> ................ -. - - - --- - ' ----- - ----.---_---_.-- <br /> --------_.-.1----------.----_---_-.-_-__- -' -- <br /> r <br /> r , (Draw existing and required addition on n»,nmn side) <br /> | hereby certify that | have prepared this application and that the work will be done in mcco,dmm^w with $mm Joaquin <br /> County Ordinances, State Lpmm' mW Rules and Regulations mfthe Son Joaquin Local Health District. Home owner wrlicen- <br /> sed mgenmuignmtum»cerHfies the YoU*v"ng: <br /> ^I certify that in the performance of ,he work for which this permit is issued, n shall not employ any.person on such manner <br /> as to bV ' - Compensation laws wfCa|�oxnfm.` <br /> Signed ---------- - --------- Owner <br /> By -- -i---.----- <br /> Title ...------.-- ...... -------' i <br /> (if er than owner) <br /> RTMENT USE ONLY <br /> Rno| |nxpncMonb^ -- --------------------------------------- --------.'Dote -' -.--�-- � <br /> ` |N LOCAL HEALTH DISTRICT ~ x�� \ ' <br /> �'- -- ��� t � <br /> E. H. 9 l''68'Rev <br />