Laserfiche WebLink
g <br /> V"1 <br /> FOR OFFICE USE, <br /> ......... A►►LICATIOm r*JR RANITATION PERMIT <br /> r z . <br /> - <br /> (Complete in Tdplisate) Permit No . <br /> .... ...... ..... .... ..:...... This permit Expires/ neer From Date luttd <br /> Dote Issued ;,... , ...... <br /> Aoplitation Is hereby mode to the San Joaquin Local Health District for o permit to canstruct and Install the work herr In <br /> described, This application Is made InGcompliame with County Ordinance No. 3+19 and oxlsfing Rules and Regulatbns,. <br /> JOB ADDRESS/LOC4TI // /. ...... .✓.. . 6.J...Ue � CENPhUanPh•TaRsAesCT <br /> Owner's Name .7 ... . <br /> Address ge h // <br /> _ e <br /> Contractors Name . �i .. .... .... .................License f .. .... . <br /> Installation will earve ! Residwce <br /> r <br /> Q' trfrssent Hous&C3 Commercial QTraltw Court Q <br /> Mrtel Q Otho <br /> Number of Irving units, Number of bodraoms .........._.sarbage Grinder Lot Sire t s �' <br /> Water Supply, Public System 4ind r ome ........ . ».._.... ................................................° hivall Q�r�s'rs <br /> Character of soil to o depth of 3 feet, Sand o Silt❑ Gay [$!Peat E3 Sandy Lawn❑ Clay Lb" <br /> Hardpan❑ Adobe❑ Fill Material .......... .If � t <br /> Vee,fYPE :,w.rs',r aiA x„ <br /> [Plot plan, showing size of lot, locoti(m of system in relation to wells buildings etc must be plead.* A"t a <br /> NEW INSTALLATION, (No septic tank or seepoge pit permitted N public sewer Is pvoilo64 slrlthfn 4001 <br /> it PACKAGE TREATMENT [ ] SEPTIC TANK j ] Sw - Liq;Ad <br /> - Capacity, .................... Type ........... Material ... No a V <br /> IkM {x $ <br /> �=�}^ .Distance to nearest Well :. Foundation .:.. ... ...Prep , ,' <br /> }�v LEACHING LINE ( ] ..No. of Lines ...... .. .. . Longth of.each line. ..:: Talal Letsgm� i x` '".Jr`i r� , <br /> J <br /> C <br /> 'D' Box ..... ... Type Filter Material ................Depth Filter Motor ... <br /> } <br /> 131--lance, to neatest, Well .... .... Foundation .... ., Propwh' Lin• •. <br /> ` SEEPAGE NT i 1 Depth ........ r <br /> Di4,m& '-.... .... Reck Filled Number ...... .:. . lled Yes <br /> Water Table Depth <br /> .Rode$ize ....___... <br /> Mstance to nearest, Well ........................................FoundationProp. Llrt• p <br /> R <br /> RE►AIR/ADDITONlPr•v. Sanitation Permit ........ . ...... .. ..... Date ayl <br /> ..... .. <br /> Septic Tank (Specify Requirements) <br /> t ..... ........ . . .\... _ <br /> Disposal Fiel Specify Requirements) � . .x pp: <br /> �".-..... <br /> 6 <br /> (Draw existing and required oddities on rev erse tide) <br /> I hereby testify that I have prepared this application and that thowork will be Asn• in aaerdeate wltk is + Jeagefa <br /> County Ordinances, $tote Laws, and Ru1e1 and Regulations of the San Joaquin Leta' Health District;Messes ow'",M fhtew <br /> sed agents signature entities the following: - - <br /> "I certify.that In the performance of the work for which this ponlsit 4 Issuod, I shalt net ."'ploy a" pensees he sed)tauaesr <br /> at to bac m• I•ct to W mans Compotip�tiionn�as wof Colifornla ' <br /> Signe ac✓LtiGa't .. Owner <br /> _. .................... ..__ _... . . <br /> a <br /> (if o'her than ownerl <br /> ,. FOR OEP, TMENT USE ONLY <br /> „ <br /> APPLICATION ACCEPTED BY . .t. � """ ' <br /> y . __ DATE <br /> BUILDING PERMIT ISSUED . .. - <br /> ... .... ....._. <br /> "i ADDITIONAL COMMENTS -....... - .. .. .. <br /> .... � <br /> 77 r3 <br /> _. ... ' <br /> . . . . Jc,e ,.� <br /> z .. 'r, <br /> r,z>t•• final Inspection by. .. - ""• "" <br /> r, EH 13 21x. ::1-66 Rev. 5H SAN JOAQUIN LOCAL HEALTH DISTRICT 8/78 3tl <br />