Laserfiche WebLink
FOR OFFICE USE (/ I FOR OFOLI: VSt: <br /> APPLICATION FOR SANITATION PERMIT <br /> I ICompfele in Ttiplieate) I Permit N0.73p- 1,0 7 <br /> This Permil Eepires I Year From Dan Isswd ( Dote Issued ;L <br /> Application Is hlrehN�nt p thor <br /> e SoA ioca!health D.str, t (o. o � - tt <br /> App y q c permit to construct ono mail the wort are n descr.bed <br /> This oppi-cohan :s made in compliance with Covnry Ovdanante No 549 onr�,exnnn Rias R an$; <br /> 105 ADORES$/IOCATtON D CAf ci.. - /Y�n A., rV4. . +ter Imo' CENSUS TRACT <br /> p I <br /> Owner s Nome ItC kis 1T-6-, .gyp•^f 1.. j Phone <br /> Aadeess Jlo D '�--jpe�� �C,7 ..� Ciryt.�Ti/ C.._y Zip <br /> Contractor s Nome A iz?oaA a License ♦ t J O` Phone <br /> -nsrollatton will save Residence ' Apottment House '--1 Commercial ' +oiler Court ❑ <br /> f Motel J Other <br /> Number of living units .. Number of bedrooms Garbage Grinder lot Size A'-.v �Gy <br /> Water Supply: Public Sy Nem and name Pnvote k.4— <br /> Character of so-1 to o depth of 3 peer `Sond Sih[; Clay L.i Peat 0 Sandy Loom❑ Clay Loom f-1 <br /> Ho-dpan _.I jAdobe( Fill Motar.o! It yes, type <br /> (Plot olan, showing ure of To+ 1«anon of system is rotation to walk,buildings, etc crust be placed on weverse side,) <br /> NEW INSTALLATION; INS septic tank or seepage pit perm.lted i! public sewwr s ovoilabfe within 200 feet,i <br /> PACKAGE TREATMENT f ) SEPTIC TANK i Ji// /�$iso Liau.d Depth� <br /> Copocdy .�.QQ Type�n4 `ia�illnter•ot Z No. Comportmenh 2, ........ <br /> Distance to nearest We!f /,SCI fowrdotion �v r li op. Lansi._Jr/ <br /> LEACHING LINE f}joO'�No. of ) net ( Length of each Lno Total leng!h <br /> D Box y t> Type F Iter Material YO Lf( Depth Filter Material <br /> Its' <br /> Distonlo neo alit Well )0 L) t 1oundon00s �. r Property tine SA/ t <br /> SEEPAGE PIT I 1 Depth I Diameter Nemtser Rock Filled Yet[] No[ <br /> 1 <br /> Wore+ Table Depth Rack Sae - ... ......... C� i <br /> Distance to neo1retc. WWII foundation Prop, Line.. <br /> REPAIR/ADDITION SPrev. Son lotion Permit t_ Dora I <br /> Septc Tank ISpeofy Requirements) <br /> D.sposoi tie d ISpec,fy Requirements! <br /> Draw es-sting anis req!,"Od addition an reverse ii-dei , <br /> I hereby certify that t how prepared this application end that the work will ba done in accordance with Sen Joaquin County <br /> Ordinances, Stale Laws, and Rules otsd Royvlations of the Son Joaquin Local Health District. Home owner at Itcensed agents <br /> srgnat ro C rtlfies the fallowing. A <br /> "I certify That in she perfetmance of IM work for which this permit Is issued, 1 shall not empley any Person in such manner asZ <br /> to bacon• wbieci to Warkmon's Compensation laws of California." <br /> Signed '''YYY???��, Owner ♦ti <br /> by / �- title <br /> lit o er than ow` ned � <br /> FOR DEPARTMENT USE ONLY ;,yl <br /> APPLICATION ACCEPTED BY ) -� DATE <br /> DIVIS-ON OF IAND NUMBER DATE <br /> TIONAL COMMENTS <br /> I <br /> Final Insow-on by. !-AiLd!' Dore 9.0-?q <br /> nh is 21 SARs JOAQUIN LOCAL HEALTH DISTRICT ,u risr. av r•t. 10 <br />