Laserfiche WebLink
FOR OFFICE USE: <br /> FOR OFFICE USE: <br /> #PPL|CAT6N FOR SANITATION PERMIT <br /> - <br /> (Complete in Triplicate) <br /> Permit <br /> This Permit Ex�� lYearF�� Dp�I�w� <br /> � <br /> Application is hereby made to the Sun Joaquin <br /> - Joo-�-�'-i-i�L/u/cu.|^Heo�|/H`�District <br /> i_s�-ic-+ �-x-u-permit <br /> t-~o`.'--�--'-'---'-'---|-instainstall the <br /> work <br /> k � <br /> "herein <br /> i <br /> n described, <br /> 'Thisopp||cq�uni, modeincomp|innonvi/ CuunryOo6inonceNo. 54Pon6oxshn . v|ohonu. <br /> JOB ADDDE�/ ]CA�ON � m ejz �..�.. `'�/--------''=^ '. -CENSUSTRA[T --------- <br /> Owner's Nome- -- ' Rhone <br /> ....___------.---....... <br /> ' <br /> Address........... � <br /> �|,y.......... .................... . ..........zip------ ...... <br /> ----- � <br /> Contractor's Nome-- �7������*^������' n��'°` /�`«�� .,��'-Lkanoe ��. /.�� phona' -- <br /> Installation will serve Re i� i - <br /> . � x once Apartment House [� Comnnonco| E] TnzUm, Court E] � <br /> � Motel Other-`',�----------- <br /> -' <br /> Num�e, uf |ivingvni�� �.,_-Nom6e, o� bn6rnomu--�'� 8ur�ogeQ, ndev-.|--.LntSioa.—.-�)��J[�"������-`^--- - - ^| <br /> . <br /> VVmmr Supply: Public System and name....... ----.`_-- .........-_---------------------------------------------------'---------- ----------Private <br /> Character of soil to o deRth of feet: Sand E] Silt[] [|oy Ll Peot- Sandy Loom [1oy Loam 97 ~ . <br /> Hardpan [] Adobe [] Fill Material.-_ ...�|fyes, ty ' --------- - ' <br /> (Plot plan, showing size "of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: .(No septic tank or seepage pit permitted if public'.sewer is available within 200 feetj <br /> PACKAGE TREATMENT SEPTIC TANK [X <br /> Capacity.A/00---------T y p 6.eAne........ ......Material-COO.r...........No. Compartments--------I------ ....... ----------�.Q <br /> Distance to nearest: Well----- <br /> (Draw existing and required addition on re'verse side) <br /> I hereby certify that I have prepared this application and that the work will be� done in accordance with Son Joaq`uin County <br /> Ordinances, State Laws,' and Rules and Regulations of the San Joaq iiin Local Health District. Home owner or liken's'ed agents <br /> signature certifies the foll6winq.� <br /> "I certify that in the performance of the work for which this permit is issued, I shall not employ any peison in such-manner as <br /> to beco subject to Workman's Compensation laws of California." <br /> A .................. --Own,r <br /> (if other than owner) <br /> fOR,/DEPARTf4EI`jT-jUSE ONLY <br /> DIVISION OF LAND NUMBER <br /> -- ---------- <br /> ----------------------- ...... --.��=��- ----'-,-----------'--- -- <br /> --'-----------.��,�� �/J�� �2�� �] ----'.------------------ <br /> . "� ' ` <br /> -----�---- --'--------, '^~ --.� ��` ----. ---. <br /> Rno| |nsnecixzn 6y.--------� - -' - ............. --------- <br /> «x n m /y <br /> SAN J[A1�U|N LOCAL H'` LT�'D�t0CT Amu���c« 7/76 3M 1 <br /> ' _ `, <br />