Laserfiche WebLink
FOR OFFICE USE. <br /> '? ­i�_ -I .07 <br /> .............. MR SANITATION PERMIT <br /> .......... ----------------------- <br /> APPLICATiPermit No, <br /> ....... ....... .....................• ...... (Complete in Triplicate) <br /> 7, <br /> .............I........... ............ ............ ThIsTermit-Expires I Year From Date Issued Date Issued <br /> Application is hereby made to the,Son-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. 549 and existing Rules and Regulations. <br /> JOB ADDRESS/LOCATIOk4 ......... <br /> ........ .......... ...CENSU.S TRACT <br /> Owner's <br /> ............. ............... <br /> Address ....... <br /> ........... <br /> ..... City ......1--laa qX,Phone --------- <br /> Contractor's Name -------IVYV. <br /> -•---....---••...._.._•---.......- . # --------- .............. Phone ........................ <br /> Installation will serve: Residence ZrApartment House 0 Cornmerclal :oTrailer Court <br /> Motel E]Other... ................ <br /> Number of living units:... Number of bedrooms . -.Garboge Grinder Lot.Size ... <br /> WWale.r SuP,,PjY Public System and name e _............. .........._............... ............ <br /> - ----------------------*.............................Private <br /> Character of soil to a depth cf feet: Sand 0 . Silt 0 clay F -p <br /> ] eat Ej Sandy Loom Clay Loom &I <br /> Hardpan ❑ Acloboo Fill Material _Ap.. If yes,type ...... <br /> ..........I-------- <br /> (Plot plan, showing, <br /> sizb of lo , location of. system in,relation 46�vV;ll <br /> ti,=builclings, etc. must be placed on- reverse side.) <br /> NEW INSTALLATION:*', lNo septic tank or seepage pitpermittedif public sewer is <br /> Jo i available within 200 feetj <br /> PACKAGE TRtATMEN'T -_[�] SEPTIC TANK Size........................................... ..... Liquid Depth ..... ........I........... <br /> Capacity --------........ ... Type ... .........I....... Material......_.._.._ a. Compartments ...................... <br /> Distance to neores .. Well -,..................................Foundation,....... ............•... Prop. Line'............ %P <br /> LEACHING (INE No. Of Lines --------- ---_-------- _ <br /> Length of each line--- ------ ... Total Length .4 <br /> ..... ... ....2.................... <br /> V Boxy........_... Type Filter Material ................... Depth Filter Mciterial <br /> A LA <br /> I Distanc4 to 'nearest: I <br /> --- Foundation ......................... Property Line ........... ....... <br /> SEEPAGE PIT- <br /> _-Depto ......... Diameter ................ Number .................... ..... Rock Filled Y&s- E] No <br /> ........... <br /> :7 <br /> Water Table Dept <br /> _._,;a, :..` <br /> ..............................................Rock Size <br /> lij ... 17 <br /> • <br /> Distoncajo.neares ell ......... ....... ...... ........ -F66bda <br /> tion- ........... Prop. Line ............. ........ <br /> REPAIR/ADDITION-.(Prev.-Sonitotibnl-�Oermit. ...............w_------ <br /> i .. . - ................. Date ........... <br /> Septic Tank (Specify Requirements. .._._.-...... "r <br /> ..................... <br /> 'T----------111-1-t------- ........ <br /> Disposal Field (Specify Requirements} I.Abp <br /> An rw t-T f.0 L1, ........... ......... ........ <br /> ..................... ........ ............. <br /> ................... .. <br /> Lrequired <br /> -- -------------------•--•---.....-•---_--...................._ <br /> --------------------------------------*.................... <br /> (Draw existing and reci0i e red addition on reverse side) <br /> I hereby certify that I have-prepared this application and that the work will be done in accordance with Son Joaquin <br /> County Ordinances, State'L7cf�Fs,—aAd'R-ule-s-Wn-d-Rtg-ulations 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:�-O'f '6a work <br /> a to b b* or 's , for which this permit Is issued, I shall not employ any person in such manner <br /> Compensation laws of California." <br /> M BOCKFI t-LE D <br /> Signed subject <br /> iec Wt <br /> Sig d ...?. -----------------I--------------- ...... ........................ Owner <br /> By ........ ...... <br /> .....MTf <br /> ----------_---Title .......... <br /> (if other than owner) /At SPF-c-7-rDrj <br /> PFcT-10/ j — _MR <br /> FOR DEPARTMENT USE ONLY jT F_D IT_ Vf L9'-Dn <br /> , <br /> APPLICATION:ACCEPTED BY _2rA.0 <br /> ---7...I...................."­............................ DATE ...... <br /> BUILDING PERMIT ISSUED .................... <br /> ADDITIONAL..C..O...M...M....E.N...T..S.. ------ ----8......... ....... WA ...;... <br /> 7....... <br /> ....... <br /> ...DATE ... <br /> -- <br /> A ' --P <br /> ........ .4 ..... .4 <br /> .............. ........... <br /> . ... .... . ...... .............. ........V......................... ..............•....................7.Zl�01 <br /> Final,ns P <br /> ............. <br /> ............. .. <br /> !�ctl( t <br /> e —rte <br /> .... ..... <br /> SAN JOAQUIN' LOCAL' HEALTH DISTRICT <br /> E. H.13' 241•'68 Rev. 5M -7 1 n j <br />