Laserfiche WebLink
FOR OFFICE USE: " 7 <br /> • - APPLICATIOP--FQR SANITATION PERMIT <br /> 'r --------- -------------------- a Permit No. -. 9 <br /> (Complete in Triplicate) <br /> --------------------------------------------------------- <br /> This Permit Expires 1 Year From Date Issued bate Issued <br /> Application is hereby 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. 549 and existing Rules and Regulations: I <br /> JOB ADDRESS/LOCATION --------------------5a7_--- outh-_DAV1d__ V` _.-_-S _�Cktpl>,-..- - ;EN5U5 TRACT _-----__-_--_-_-.-_-. <br /> Owner's Name -------- ---------Rabar.t__BaumbaGh-----------------------------------------------------------------------Phone --------3'b9---32-74------- ' <br /> Address --.-----------------------14.ZQ_-Maripaaa--V1�--------------------------------. City ---Ladi y___ .a.------ ------------------------------------------- <br /> Contractor's Name -----------------Parrish- &---S-ons-a---Inc------------ )---License # ----.1005 -- Phone --.-46o9 97 <br /> Installation will serve: # ;Residence [ !�partment House❑ Commercial ❑Trailer Court '❑ <br /> Motel ❑Other --------------------------------- .......... <br /> Number of living units: one--- Number of bedrooms ___2------Garbage Grinder --------- Lot Size ------7-5y,L-5p----------------------- <br /> Water Supply: Public System and name ---.- ------ -Private <br /> Character'of soil,to-a depth of 3 feet: Sand'❑ , Silt❑ Clay-❑ Peat❑ Sandy Loam 'o Clay Loam ❑ <br /> f Hardpan ❑ Adobe.gC 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,) <br /> PACKAGE TREATMENT [,] SEPTIC TANK[ ] Size- --------}------------------------------------- Liquid Depth -------------------------- <br /> Capacity _ - Type --------------------- Material---------------------- No. Compartments ---------------------- V <br /> Distance yto nearest: Well ___-____---_----------------------Foundation --------------------- Prop. Line -----------------­---- <br /> LEACHING <br /> -.._-_-- ----..---_LEACHING LINE [ ] No. of Lines ------------------------ Length of each line-.._----- ------ ----- Total Length ..__--_.__. <br /> 'D' Box ............ Type Filter Material --------------------Depth Filter Material ---------------------------------------_---- q <br /> s <br /> Distance to nearest: Well --------=---`---------�Foundation - ------------------ Property Line ----------.-----.--_.--- <br /> SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ------------ :------------- Mock filled Yes ❑ No C] <br /> Water Table Depth ------------------------------------------------Rock Size ------- if <br /> L 4 <br /> Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ---------._-_--_--.--- r <br /> *WAlit/AO v#6N(Prev. Sanitation Permit.# -------------------------------------------- Date ------------:---------------------J <br /> Septic Tank (Specify Requirements) ---- ------------------ -- --------------------------------------------------- ---------------------------•- ------ <br /> Disposal Field (Specify Requirements) -----------$5---Feat-_Li�aach---anis._-3-611---dia.__-dra1.n-_pit---------------------------- <br /> ------------------------------------------------------ -------------------------------------------------------------------------I------------------ - <br /> - ----------------------------------------------------- <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed --------------------- - arrlsh. & Qn_ - ----I_MQ-• ---------------- Owner <br /> BY -------- -- - 1 8S- �b aT -i8h ----------- Title -------- RE- ----- - ---------------------- ---------- <br /> (If other than owner) i. <br /> FOR DEPARTMENT USE ONLY t <br /> APPLICATION ACCEPTED BY - DATE --- ._A5_-_9V• <br /> BUILDING PERMIT ISSUED ----- ------- -- -------------------------------------=--------------DATE ------------------------------------------- w <br /> ADDITIONALCOMMENTS ---------------------------------------- ---------------------------------------------------------------- ------- ----------- ------------ <br /> ----------- - --------- <br /> �= s-q ----------------- <br /> .�.. � _ j - o =_�-:Via; <br /> - ---- ---- - <br /> -------- ,e. ------------------------------------ ------ <br /> Final Inspection by- --------------------------- izP ----- --------------------Date -------------------------- ----------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT } <br /> E. H. 9 1-'6$ Rev. 5M <br />