Laserfiche WebLink
+t'''�.E?74•.r <br /> FOR OFFICE USE <br /> T t APPLICATION FOR SANITATION PERMITF 'r <br /> Permit <br /> (CompleM In Triplicate) <br /> $ ...... . .... . This Permit Expires 7 Year Fears Data Issued Dab Issued a <br /> .. <br /> o <br /> . Application is hereby made to the San Joaquin Local Health District for a permit to comtruci and Install the'wgr Mri <br /> + r described ThIs application is mode in compliant with Goun Ordinance �N ck. 549 existing Ru es and Repulatto sC <br /> JOB ADDRESS/LOGATI J/.2?-5 ._ ....V�p[ CENSUS <br /> Owners NansI. .. .._ Phone <br /> aEa r Y, <br /> V rh" Address ..._ ..,7 7,� r .... a(. city;, <br /> p <br /> y Contranor s Name . ..fp-i..rn.c.�r..1... ,-s.. . Ifit .. .7t�1. ;cense# .pP3a.>.. one <br /> Instal!at on will serve: Residence E2Aportment House C1 Commercial❑Trailer Court ❑ <br /> t"+ Motel ❑Other :: ... - <br /> Number of living units: Number, of bedrooms '.Garbage Grinder Lot Slze <br /> `Prfv i <br /> Water <br /> SuPP Y: Public <br /> System and name .:... . . :: .. ..._ . .. .. r <br /> Characterof l roa deptof t <br /> 4 <br /> 3 feet+ Sand❑ Silt❑ Clay: ❑ Peat❑ Sandy Loam ❑ Cl.iy L��oam <br /> Hardpan❑ Adobe ❑, Fill <br /> Material ...... ..... If yes, <br /> _yvv"ldn+lr . <br /> ,i (Plot plan, snowing size of.lot, location.of system In relation to wells, buildings, etc. must be placedr`on"rr E <br /> C <br /> � , r NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer Is available it <br /> thiII <br /> i <br /> PACKAGE TREATMENT [ ] SEPTIC TANK[ ] Size `' Lnufd�lept a <br /> .�, <br /> •,. r¢i �.. Capacity -.. Type Material .. No Compa M�nb m -L <br /> Distance to nearest Well ............ ... . .Foundation Prop+lCns=' <br /> r5✓; k. sr � qr <br /> Sy LEACHING LINE [ ] No. of Lines .:.. .......'Length of each line._................ . . Total Lengh `�.... .. � <br /> D' Box _ Type Filter Material ...._ ... Depth Filter Material .: ''' x n <br /> Distance to nearest: Well Foundation '.. ..: Propertyr Line ' <br /> SEEPAGE PIT [ ] Depth .. Diameter: Numbe• - . ` Rock Filled�Yrs°�❑ <br /> c � t <br /> Water.Table Depth ...... . ....... . . Rock.Size <br /> • �•�'"'[� Distonce to nearest: Well ._..._ :. ....... .. .Foundaticn .. ,,Pdip LIna <br /> REPAIR/ADDITION(Prey. Sanitation Permit# ...:.. .... .... Date <br /> '" C t" Sect c Tank (Specify Requirements) -...:__ <br /> Disposal Field (Sp nfy Requ r nts) p <br /> (Draw existing and required addition o reverse side) <br /> I hereby certify that r have preparedthis application and that the work will be ileac in accordance with Sasa`JOaq tin' 1- <br /> County. Ordinances;'Stab Laws, and Rubs and Regulations of the San Joaquin Local Health District. Home ewner,pr ifeii <br /> sed agents signature certifies the following: - - <br /> r <br /> "I certify that in the performance of the work for which this Perri Is Issued, I shall not employ any person in'such <br /> A as to become subject to Workm mpentation laws of California." <br /> Signed .:. Owner. �T a• { ,S.Yk."e. ^N* 4`� �} ' <br /> { ........... . W <br /> By �.�f ... .. _... Title .•�•� 4 y <br /> (Ifother than owner) <br /> , <br /> _ FOR DEPARTMENT USE ONLY <br /> ' Y�FAPPLICATIONABY :.// +rc-t�I'r <br /> CCEPTED <br /> Y a c,BUILDING PERMIT ISSUED <br /> ADDITIONALCOMMENTS .._.... .... .. �.. > <br /> .... ....:_ .... .. .'z .rirt-' ^'W5tt�5., h44Rk' jd",Y . <br /> " Final In spedion by: . //Y _......:' .. . ......... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT Ls _ <br /> E H 4 1.'68 Roy. 5M ' i + a4r e <br /> X: <br /> LT fs ,y' <br /> l t <br /> icy }SsrY '� <br /> Ilki <br />