Laserfiche WebLink
FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT 1 <br /> (Complete in Triplicate) <br /> Permit No. 7 <br /> 1••---• ............. _ This Parmitxpires ) Yoarf <br /> ront Dp , tIed <br /> A lication is:-hereby trade to the;San q : � k <br /> Pp Joa uin'Local Health Di trio for; a permit to con:trutt and install tie work he in <br /> described; Thi's application is made W compl+dnce'with Coi nty: Ordinance No. 549 and exist'ng Rules end �Regylations: <br /> . . <br /> ii08 ADDRESS/LOCATION. ' , . -�' lj=- ._ <br /> CC// : EISVS TRACT �,_... i.. <br /> Qwner s Name 1. ' � , ' -.. _�. ;_ Phone , .. ".'...... . <br /> pp �j <br /> lddri;ss .. City d <br /> oniractar's Name ___ <br /> -- ------ ---- ...... ......i'--:. ,- .. .. t. ..Laren # .... ._ ... ... . ..... ... ... <br /> Phan ..........................!_7 <br /> lnstolla#ion will serve : Residence •par#merit House fl Cor merc#al Orraller,61-urt"tj <br /> . ... a _.-.--._....i• <br /> ...Motel ❑-Other----------+......:... ....:....•- =-----._......; ; • .... <br /> hfurnber of living-units:_. ____ = Ns tuber of bec�roorns- Garbo a Griner ... i <br /> A�:- g ;Lot Size, <br /> (Nater. Supply, Public System ohd.name <br /> ,. .s':..,.Private Q ..,. <br /> 6oracter of soil to a depth of 3.feet Sand <br /> ]>. ...Silt. .. ...Clay, oartOP . l. . ] X [ .yl ..... <br /> Hardpan [j Adobe {. .Fall Material If.Y$s.tYPe.. -- <br /> (Plot -plan, showing size Of loi•,-location of systema In relationto wells; -buildings; etc;= must -be placed- ori­redersi-side.) <br /> ACICAGi:TR ATM NT No s5EPTank or see a e:p' tl..if public••sewet.ts available;-w3ttiin�QO dee?, <br /> NEW INSTALLATION: ( P P 9 it.' errhitte <br /> [ 7- .. iC TANK .J. Size_..... uyulsl oe1 f <br /> .j... �.._.. L. -r•....rf''.--<;.....,. `7. ptlt -a•t.cief,•_._ <br /> Capacity hype _ -- Material+_ ............... No' Compprtments'h l.... <br /> Di'stanze to nearest: Well ................ _ ... op; Line._ ...d <br /> Fdu ndatian Pr <br /> - -• , <br /> C'EACHING LINE .[ No. of Lines Len th of: east like-..v_____-______ ____ Yotai Leng <br /> .._•__ -_ <br /> . <br /> •D; Box Type Filter, Material ..:.. th: FilterMa#era <br /> :.. -- ' <br /> s Distante to nearest: Well -- :.---..•_... Paund,atloh :......:......:...... Property I Ine M <br /> SEEPAGE PIT [ ] Depth ' ._ ` __..... _ Diameter Hurn ar Rock Filled Ye# N , <br /> i . Water Table ' .. , :Rodc-Size ' -- ,. <br /> Distance to.nearest Well F . _Foundation -- Prop. Lins <br /> [I;FPAIft/A0DIYI0N'(Prev. Sanitation,Permit-# Dnto.__.L�.:; ` _ Io.; <br /> Septi <br /> c Tank;(Specify Re4uireinenis)- <br /> _ <br /> � <br /> ..... -- :. <br /> Disposal Field (Sp a ify : equirhents) 44 � , <br /> - 04 _ <br /> ------------__ ___________________ _ __ _- ___ __ _ .....ta <br /> i. E. .(Draw existing and-required 6dclltion n•-reverse-side) <br /> I Ihereby certify thbt i.have.prgpared.this appfiicallon bnd .`thaif ths..work,-W H)•bs..�ipr+¢,•in'.accorrddtice with Nn.. in <br /> Sd .taaq <br /> vnty Oedindnces, State Law*', arid Rifles and Regulations of the San ;Ieaquin loc+arl Health:District: He; owner pi lac n• <br /> sed agents signature certifies We foilowin ; ; ' ; ... = ... <br /> A N, <br /> " certify that in the..p4rforinarkce.of tf+$.work f .r:whic this .parmit. s.i-s;ued,.1.s�afl.not_amoloy.,Mony Perjan._in.such.*an or <br /> to becoin sWe' t W' kman's Ca eirsation laws'of Californhs." <br /> Signed - -•-_i............ :......: . :.... . .....�o...__ i- <br /> ......F...,. <br /> i 11// <br /> �_ wn r <br /> O <br /> y <br /> l <br /> _________________________a............. <br /> ,._....t_____,_ _._ ... ---------, Tate _____.} _ <br /> _ .s <br /> lif other than`owner).. .. t .. <br /> ` ARTMENT U E NI.Y , <br /> APPLICATION ACCEPTED SY <br /> i F ; ~ .�� <br /> BUILDING"PERMIT 155UED •- _ _ .w_,. b_ �. AFE �. 1 <br /> _._.._ .. <br /> ADD 10 AL O <br /> ENTS --- P �-- _. tc.an_ �•Jr. . .r_ <br /> .�._._ _ <br /> ------------------------ <br /> �-.-. <br /> Final Inspection by: .________-- [ Date .6-fir...~.'� - -� ............... <br /> __.----- <br />' EH �.3 21a 1-6fi I3ev. -- --- --- -- -------•----�------,_.........-------_...----_----_--------_----. ...._.._ � <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M <br />