Laserfiche WebLink
FO OFFICE USE: <br /> APPLICATION FOR- WITATION PERMIT / <br /> �� "; Permit No. <br /> H. :r (Comple <br /> = te in Triplicate} <br /> --------- ------- --------------------- --- ` . �-1 <br /> ,�. Date Issued ---F--_L1-1 <br /> This Permit Expires 1 Year From Date Issued <br /> Application is hereby-made to the San Joaquin-Load!-44ealih-District-for-.a_perm it..to-.construct and :instali_the work herein <br /> f described. This applicatio'nYis made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION Y'�-- ------------------------------- -----CENSUS TRACT ..---- -------....-------- <br /> L'..1 <br /> Owner's Name /-_ ms's` ------------------ Phone <br /> 4 Address ------� Ems' ' +� ------------------------- ------- ----------- City 15-1 ------------------------ -------------------- <br /> Name --- `ori License # Phone 5 <br /> Installation will serve:,,,,,' Apartment House❑ Commercial :❑7railer Court ;❑ yr <br /> Number f livin units:-_-- ___.... Number of bedrooms .-Z--_..Garbage Grinder ` i <br /> Motel ❑Other -------------------------------------------- <br /> Numb o Lot Size ss'e ,X-- '---------------- <br /> ! Water Supply: Public System and name ------ r_ g---- �� L ----------- Private El <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt 0 Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam -❑ <br /> Hardpan ❑ Adobe �9_ Fill Material ------------ If yes, type ---------------------------- <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 feet,) P <br /> PACKAGE TREATMENT [ SEPTIC 7ANK'LA Size--- � _ --- Liquid Depth ��------------------ <br /> Capacity` I ._-- Type /° _,Material ---- No. Compartments_ .............. <br /> Distance to nearest: Well -----'b--' ..............Foundation 4V --- ..-..... Prop. Line ...._..__._.. <br /> LEACHING LINE No. of Lines .... ------ Length of each line. .- - ---- Total Length � .�-_._......__ <br /> 'D' Box/W-- Type Filter Materia�;J epth Filter Material ,-e-----�'y---�"-------------------•--- <br /> ' r9 �' pti <br /> Distance tonearest: Well -----77=---_�� Foundation _ ---_-------- Property Line. -�/_-.�_--_------_ <br /> SEEPAGE PIT Depth -- Diameter . --------_Number__--/.__....,--:_.__r,.-_12ocis_F_[Iled__Yes No <br /> p <br /> Water Table Depth ---- Rock Size/-�s - .I <br /> ee <br /> Distance to nearest: Well ------ .................Foundation _,---- -------- Prop. Line -_.--...:...-_ <br /> i <br /> REPAIR/ADDITION{Prey. Sanitation Permit# -------------------------------------------- Date ----------------------.----------_) <br /> Septic Tank (Specify Requirements) --------------------------- ------------------------------------------------------------------------------------- --------------- <br /> Disposal <br /> ------------..Disposal Field (Specify Requirements) ------------------- -------------------------=-----------------i,,----------------------------------------- ------:7%--------------- <br /> t.- <br /> -------------- <br /> W t <br /> --------------- --------------------------- ------------------=-------------------------- -------------------------------------------------y---------------------- - <br /> . - I <br /> ------ ------------ E - r -- <br /> 1 {Draw existing and required addition on reverse side)', t <br /> I hereby certify that I have prepared this application ;and that the work will be done irikaccordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health'District. Home owner or licen- <br /> sed agents signature certifies the following: �. <br /> "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> t � <br /> Signed ---------------------------- -- - --------- ------ - -----------------i----------------- - Owner <br /> +� j <br /> (If other. owner <br /> PP FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY _ s ----------/0,/,d-lz9=- ---------------- ----- ---------------------------- DATE ' 6--/=7-/---- <br /> BUILDINGPERMIT ISSUED ---------------------------------------------------------------------------- -------------=------ -------DATE ---- --- ---------------------------------- <br /> ADDITIONAL COMMENTS ----------------------------;-- ------- ----------------------------------------- ------------- --------------------------- <br /> ']�'- - ---------- ---- <br /> ---�y ! --------- ( �— -?/----��--- ------------------------------------- -------- <br /> ---------------------------------------------------------------- -----------------------------------------------------------------------------=----------------------------------------------------------- <br /> -------------------------------- -- -- ----- - - - ------------------ <br /> - y <br /> J Final Inspection b,, --- ------ ------- ---------- --- ---- Date pr '. {� ------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT !� <br /> E. H. 9 1-'68 Rev. 5M <br />