Laserfiche WebLink
`"F R•OFFICE USE: 1'. PPLICATIOK FOR SANITATION PER--0 <br /> Permit No. <br />�.-... .,..........."................. <br /> .................:.... {Complete In Triplicate) <br /> \ !\ �........�7. <br /> ...............I. <br />�................ Date issued .. ..-.��.....3. <br /> This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install theYwork herein <br /> described. This application isle® i lionce with Couiaty,�Qrdinonce .,NNo. 549 and existing Rules and Regulations: <br /> �4 .................. <br /> JOB ADDRESS/LOCATION .............•-----............-. CENSUS <br /> _ <br /> - _.� <br /> ... CE 5U <br /> �- Phone ...................... <br /> Owner's Name � .. (ii ......... ,. :., ..... <br /> Address <br /> ..................... <br /> ..... .,. .'.; ...City i� '........................................................ <br /> �77��.- Phone - . ... ..... <br /> .�' s, c_.c:.......License #�f- <br /> I <br /> Contractor's Name ..-.i / ... . " ............... wt. <br /> I` . <br /> Installation will serve: Residence (3 Apartment House-0 Commercial-VTrailer Court 0 <br /> - <br /> Motel ❑Other ......-- --0.."^ �...f =i. ....� �r� � <br /> i. .� <br /> --. Number of bedrooms � ..-_Garbage Grinder= =- Lot S I z e f/�.�i ' �-• -• <br /> [ Number of living,units:...._ . r vo <br /> t Water Supply: Public System and name --_--__-..••...............•••-•--........... ........ ....... <br /> P i to <br /> i ) 3 , <br /> Clay Loam [] <br /> Character of soil to•p depth of 3 feet: Sand.❑�.,.Silt)]-- Clay..-❑ Peat❑ Sandy Loam )] <br /> h p , Hardpan E] Adobe,e Fill Material .'..`... ... If yes,type ............................ <br /> J , <br /> {Plot plan,-: showing;size of lot, loca63-6. of. system In relation to wells, buildings, etc. must be placed on reverse side.) <br /> septic tank or'seepbgelpit permitted if public sewer is available within 200 feet,) / 4v <br /> u f <br /> P CKAGE TR ATM NT [ ] SEPTIC TANK (J Size f� ...... liquid Depth ............ <br /> . ' Na'' <br /> 'Compartments .... .......... <br /> Capacity/. p- - •-- Typ i ' •- Material ejpv .-: ompart� t .` •� <br /> —Dist na ce to nearest: Wel f :.: ..•.Foundation ..� ...-•-•--- Prap. Line . ��:_..-.....:. <br /> LEACHING LINE No. of Lines <br /> --- Length;.6f hath line.. -.: ....-•-.•— Totbi Length <br /> D' Box - ._ .. 'type Filter Material � Depth Filter Mateffal _�__. .•...• <br /> f - -ell ... oundationI�.......;::._.. Property+Line ............... <br /> SEEPAGE PIT <br /> Distance <br /> e tfh ce to neareslt Diameter ? ••_ }Number ....:--f_.. f•_•_^-:• Rock Filled Yes { Nd,. <br /> Water Table Depth ...__ --cr....1............... ...........Rock 5iz6/...� ' , ,` y Ir <br /> � � <br /> ro Llns ` <br /> Distance to nearest: Well ��� - - ' .•`Foundation "/V; ..... P� - ,~. <br /> n <br /> .. Date ..................................ys <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ...... •••---._.. ° <br /> Septic Tank (Specify Requirements) ----• ........... .................. -------- .................... ..... <br /> Disposal Field {SpecifyAequirements) ••--'�:' - <br /> ` <br /> .................. <br /> _ ` ...•..... ............................'-......____.......-•-i..._::........-'----•........_•---..._.............-........._....... <br /> + (Draw'existing and required addition on reverseysidel- - ..,. M <br /> f�. <br /> I hereby certify that I ,have prepared this bppllcotion and that the work will be done in accordance with Stn oaquin <br /> County Ordinances, Stdte Laws, and Rules.and Regulations of the San Joaquin Local Health District.Horne ownier'er Iicen- <br /> zed agents signature certifies the following: <br /> "I certify that in the perforr' once of the work for'whlch 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 --..... ... .. ....-- ... ................. :..... . Owner <br /> -.. ° Title . ... _ ...... <br /> Iif er than owner <br /> ` ARTMENT USE ONLY <br /> t .._ <br /> ...................... DATE,.... :.I,�:.— 3........---.... <br /> APPLICATION ACCEPTED BY ..... <br /> f BUILDING PERMIT ISSUED .......... - ...................... .... <br /> DATE ..... <br /> ADDITIONAL COMMENTS ....... . . . ... .... .. ............. ....... <br /> �. <br /> .,. ... .:................................... .......................... <br /> ... ... ..... ........ ................... --..................... <br /> . <br /> 1. <br /> ............-....... ..........-•- . ............6 <br /> Date - -� <br /> Final Inspection by: .. . ............... .. . ... =....:`�...._...'-- ......... . . <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 13 24 1-IAQ De„ 9k 4 - — 7/72 3 M <br />