Laserfiche WebLink
.R C FFICE USE: APPLICATION rOR,SANITATION PERMIT Permit No. <br /> -- ---------- -- --- ----------------------------------- <br /> (Complete in Triplicate} <br /> ----------I-- - -- -- -- ------------------ Dote Issued <br /> This Permit Expires 1 Year From Date Issued <br /> Applical ic n is here-by made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No 5A9 and existing Rules and Regulations. <br /> JOB ADDRESS/LOCATI ay_Efl�_rA ----(4ChwWu_fV -------- <br /> 0 --------2---- <br /> *41--150— -CENSUS TRACT --------------a----------- <br /> -------------------Phone <br /> F. <br /> Owner's Name ------ - ---- ------ ---- -- ----- ----------- --- <br /> --------------------- City <br /> Address ----- ------------ --------------------- <br /> F4,_-It--- ,-�, _-- - -�!_. -i ----5 <br /> 0-oln ------- Phone <br /> Contractor's Name ------------License #li� <br /> Commercial railer Court <br /> Installation will serve: iResidencq.-D Apartment House�F] C XT <br /> MotelR Other -------------------------------------------- <br /> bc� Grinder ------------ Lot Size _;9.4, <br /> Number of livingunits: ----units:__-- -�ber'of bed-rdoms -----------_Garge -------------- <br /> --------Private <br /> Water Supply- Public System an name ----------------------- <br /> ---------- ------------------------------------------------------------------ <br /> 41 �_k 'd I <br /> -..w—C-harticterof-soil-f6lci-depth-of-3-feetr—Sand-TE4tS-itt�C <br /> - -- <br /> 4 'd Adobe%PO4- Fill Material ----- If yes,type <br /> ------------- ---------- <br /> Har pan <br /> A <br /> tio'n of sys*rn relation to wells buildings, etc. must be placed on reverse side.) <br /> (Plot Plan, showing size of'Ioi,-*I&b ;in <br /> -relation <br /> within 200 feet,) <br /> NEW INSTALLATION: (No ase tic ibnk�or seepalge pit permitted if public sewer is available <br /> ------- Liquid Depth -------------------- ----- -I <br /> PACKAGE TREATMENT ]'-.;-SEPTIC TANk:J Size---------------------------------------- <br /> Capacity,---------------- --,,.Type- ---------------------- Material------- -------------- No. Compartments ------ --------------- Vb <br /> - --------------- Foundation ---------------------- Prop. Line .------ <br /> Dis'tbnce to nearest: \We -------------- <br /> ti <br /> LEACHING LINE,- No-.,4-of Lines <br /> - <br /> -------I- Length of -------- ---------- ------ Total Length ------------ ---------------- > <br /> --- <br /> Depth Filter Material --- ------------ <br /> D­13;5x—,7t��Types,Filter Material --------------- --- ------------------- ------ <br /> - --------- -------------- <br /> W611 1�60n8ction -- ----- --------------- Property Line <br /> Distance ------- ------ <br /> disty e to nearest. <br /> ­ I No C] <br /> h ------ <br /> SEEPAGE PIT'-'.(, --- umber ------------------------ <br /> Dept Diameier 2\--------- Rock Filled Ye� 0 <br /> P-------------------Rock Size --------------------------- ------ <br /> ible,.Dqpth--------------- --- -------- <br /> ater.,Td <br /> 11 Prop. Line ---------------------- <br /> st - <br /> Di once to-ii'6&est; \��eil - --------- ----------- -------------Foundation ------------------- <br /> VIC <br /> RIEPAWADDITION.(Prev. Sanitation Petmit ___r.------------------------- Date -------------------------------- <br /> -- 777 ---------- V-- --------­ -- - t-------/-------------------- <br /> Septic <br /> --------------------Septic Tank (Specify Requirements) --- _ 7- ---------- --------i-- <br /> Disposal Field Specify -Rouiremehts)--------- <br /> --------- <br /> , -A V __X_ a------- ---------- <br /> ----------------------- ---------I---- ------------------------------------------------------------- <br /> --------------------------------------------------------------------------------,---------------- --- <br /> ---------------------------------- ---------------------------------------------------------- <br /> - <br /> (Draw existing on--,required addition on-reverse.side) with Son Joaquin <br /> I hereby certify that I have prepared this application aV <br /> - or <br /> and-that the wk will be done in accordance <br /> County Ordinances, State Laws, and Rules and Regulations oUthe SaIn JoaquirfLo-cal H *_fih District. Home owner or Hcon- <br /> sed agents signature certifies the following. <br /> "I certify that in the performance of the work for which this-permit is;issued;-4htill no�iMZploy any person. in such manner <br /> as to become subject to Workman's Compensation laws of California <br /> n <br /> ,i - .-+- <br /> Signed -------------- ------------- -------- ------------------------------------- Owner . C 3 <br /> -Title TJt� �,-L--- --------------------- <br /> _ _ _ .c----- <br /> By ------------- --- - -------- -- ------ - <br /> ---- ------------------------- - <br /> (if ofhe t an owner) <br /> J <br /> FOR DEPARTMENT USE ON Y, <br /> APPLICATION ACCEPTED BY ----------------------------- --- - - ------ DATE ---- ----------------------- <br /> - <br /> , - <br /> BUILDING PERMIT, ---------------------- DATE - <br /> ­------ <br /> ADDITIONAL COMMENTS ---------------- ------------------------------ ---- ------m-------------------------- -----------__----------------------- ------------------- <br /> - <br /> ------- ---------------------------------------------------------------------------------------------------I--------------------------------------------------------------------------------- <br /> ------------ ----- ------ ------------------------------------- <br /> ----- ----------------------------------------------------------__-------- ---------------------------- ------- <br /> ----------------- - - -------------- <br /> ------- ---------------------------------------------------------------------------------------------- -----Date --- --- -------- <br /> FinalInspection by- --------------------------------------- ---------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH TRICT <br /> H. 9 1-'b8 Rev. 5M <br />