Laserfiche WebLink
'•+*gym+ '�..s=��! ' -- - <br /> . -FOR OFFICE USE: <br /> -APPLICATIOWI=OR SANITATION PERMIT <br /> .......:......... <br /> .......... Permit Permit No. 'a <br /> :......... ........................... .. (Complete In Triplicate) 1 <br /> ....................................^-- � Date Issued ......- <br /> --•----•-__-•- - .., This Permit t Ysnr' ram Date ..,..,..- -- <br /> ----...... <br /> Application is hereb�i made to the San•,.Joaquin Local-Health-Districrf& a-permit`to-tohstruct and-Install the work herein <br /> e i <br /> described. This application is modn compliance with.County Ordirionce-No. 5,49 and existing Rules and Regulations: <br /> � <br /> _ .. ._.. - <br /> - <br /> JOB ADDRESS LOCATI N p / . ,l • .. <br /> / O �El_.. /......�.[� , '` --s- •----- _.. .... _ ..CENNSUS TRACT . d <br /> Owner's N i2Rr[1C -� <br /> `r�- nn <br /> {, Phone <br /> Address .. Q.-. !-�.. llfllr ' �` ....... -: l� . �.............. : . .... <br /> { city <br /> •��� Pho 7' •Z <br /> .....:. . •__. . <br /> Contractor's Name ._V_. ._a_.. c c� - .,:: - License il� S . I... Phone <br /> Installation will serve: j Residence Lartment Houseo Commercial oTrallor Court 0F <br /> Motel ❑Other., -- '-.....'.------- ---..... .. � t <br /> Number f livingunits: <br /> ' -~ ,� .� � r <br /> o units.'___.__..... Number of bedrooms' ::Garbage Grinder:......:.:... 'Lot Size <br /> Water Supply: Public System and name i <br /> _•________________________•.........•..........a---f----............_---_--.- _-----:._... <br /> ..................Private <br /> Character of.soil to a depth of 3 feet: 'Sand <br /> p 0. Silt Q Goy ❑ Peat❑ Sandy Loam. lay loam ❑ , <br /> Hardpan 0 Adobe fl -,,.Fill Material.............if yes,type ..... ............ <br /> (Plot plan, showing size of lot, location of system in relation totes! <br /> .wells, buildings, etc. must be plaon reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit,permitted if public sewer is available within 260 fee ,}t —mo i <br /> PACKAGE TREATMENT ( ] SEPTIC TAMC ] Size.................................... - <br /> ......................... Liquid .Depth <br /> -- Material.........__. No. Compartments ..:.......:..:. <br /> opacity .................... Type ---- --•----- _..---• <br /> Distance to nearest: Well _. . <br /> .Foundation t^. ............. Prop.Line ...:....:.... <br /> No. of Lines -----�------..--•-••---....-•------ ••--•--•---- .:.._... . <br /> •. . Leline . ' s7o <br /> LEACHING LINE C ] N Length of each -------•--••--••---...----- Total Len th�•.__ <br /> ............ Type Filter-Material .Depth Filter Material ..':-•--•_-• _ <br /> h µ .......... <br /> ,.-yam ,.,�-•- -•;} f <br /> Distance to nearest: Well :...:-•...........• Foundatlo Property. Line #' <br /> SEEPAGE PIT ( ] Depth .••-------------.... Diameter .•--•-----:----- Number .---------......•---------- Rock Fired ' Yss [] No 04 <br /> Water Table Depth <br /> --------•......_---------------------------------Rack Size .........,.................. <br /> ._.. ; <br /> Distance to nearest: Well _---Foundation i ' t .- <br /> REPAIR/ADDITION(Prev. Sanitation Permit* -------------------------------------•----•- Date ._____..__.._...--.. .......,,-•..] <br /> Septic Tank (Specify Requirements] -........--------............................................... ---....:.....- . \..:.. <br /> 7 ..__... <br /> Disposal Field )Specify Requirementsi -_:__-- t a ------Ld_ �.±...s`.J rJ.Pr--.•...+._.,oc"XL9---.:.a�-- -1-s --�X-•1 .....a2p <br /> 00•F hs_r�.. I�l�a ]n_x �._..�;_l3ic......__._l�w _E L.-ARK,..................................� ------L -------- _ _sn <br /> - <br /> (Draw existing and Yequired addition on reverse side} <br /> I hereby certify that I have prepared this application and Wa tt!a work will.-be done- in accordance with San Joaquin ;y <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, 1 shall not employ any person in such manner <br /> as .to become subject to Workman's Compensation laws of California." <br /> Signed .......... ---------------------------------------Owner <br /> BY = f Title ...0a)eve�G- r......�L'.._��E,����� <br /> --------_---_--- 4 <br /> (If other than owner) <br /> ri <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ------ r_ -- •- DATE_------.��. Z ..7�._ _..:...: <br /> ------------------- <br /> BUILDING PERMIT ISSUED ----•--•--------------- ------ ---------------- ...............DATE ......................................... <br /> ADDITIONAL COMMENTS ----- <br /> ----------- -•----------------- ---------------• --........ ........... ..._..------ -• --------------.. .............. - <br />' --- ------- - --------------------------------- <br /> ...................... <br /> ........................... <br /> Final Inspection by: _ <br /> 01 13 2b 1-6r3 /`�.e - -------- ----- Date - � / <br /> i3ev, SAN JOAQUIN LOCAL HEALTH DISTRICT 8I7]! 3M <br /> � J <br />