Laserfiche WebLink
„ FOR OFFICE USE: L4- 47 - <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete In Triplicate) Permit No. __.-..- <br /> This Perm It Expires 1 Year From Date Issued bate (slued / . <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: <br /> JOB ADDRESS/LOCATION . ............................ ........CENSUS TRACT .......................... <br /> Owners Name u. 1.-3, ._..... - t._C11.Ar'_f.`}s.t� ....................................................Phone L:.-�:77.P5-�/....... <br /> -------- <br /> Address ...... M._�._ ,..S.L. •--------• ........................ City .. �T�LjCr..i.c�iJ........... . <br /> Contractor's Name ... -------W Ox2i-4 -----im.4.k'4_F:.....•••.........License # ......................... Phone <br /> Installation will serve: Residence W Apartment HouseEj Commercial[(Trailer Court 0 <br /> Motel ❑Other...... ............... .. <br /> Number of living units:----1------ Number of bedrooms ..,___:.Garbage Grinder .. .._ Lot SI ` .. _ _ e............... <br /> Water Supply: Public System and name .............................. :—......Private E3 <br /> Character of soil to a depth of 3 feet: Sand Silt.Q Clay 0 Peat(D.- Sandy Loam Q Clay Loam Q <br /> Hardpan :Adobe o Fill Materlal•.A:..�•_- If yea, type............... ......... <br /> ... <br /> r. <br /> 7Plot plan, showing size of lot, location of system in relation to wells;:b6ildings, etc. must be placed on reverse side.( <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if.'pii_[.t'16irer is available within 200 feet,( <br /> PACKAGE TREATMENT [ ] SEPTIC TANK I ] Size_-- <br /> ........: ::...:. Liquid Depth <br /> ---- .......................... <br /> __ Material................. No. Compartments .J <br /> .Capacity ... TYi� -------------=---- ......... <br /> Distance.to nearest: Well ------.-•..............:.:..:......Foundation ...................... Prop. Line --_-------------_,-.� <br /> LEACHING LINE' ( ] No. of Lines ---.---_-------------- Length of each -line....................._._-.--- Total Length ........................... <br /> ri <br /> 'D' Box ............ Type Filter Material ....................Depth..Filter Material .............I.............................. <br /> SEEPAGE Distance to nearest: Well ........................ Foundation Property Line -----•--... .. .. . . . [� <br /> Y <br /> E PIT O Depth -------------------- Diameter ..............__ Number ----.----------------..----- Rock Filled Yes ❑ No Q <br /> Water Table Depth -•-----------------------------•-••--•-=•--•----Rock Size .................•............... <br /> Distance to nearest: Wf. ...............................:....Foundation .::... ..........--- Prop Line ----.................. <br /> ji <br /> REPAIR/ADDITION(Prev. Sanitation Permit# L&k.f)kkP(_-------- Date 61 ._ -- ........l o <br /> Septic Tank (Specify Requirements) .................. ..: .................................................. <br /> Disposal Field {Specify Requirements)--._.]ot7T4e_1-t• r M.�---•-D.M. -J.Q Q �__A_ L.. f4 e....... <br /> .. Y 1�_ .... .. <br /> W.U3: _ _• %S '- r it-_R---.3----� �N_ .._t. _.i=3 ..... <br /> MeT-- •---......-- <br /> (Draw existing and required addition on reverse sidel <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 Sam Joaquin Local Health,District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> 66 <br /> 1 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 bec me subject to Workman's ompensation laws of California.” " <br /> Signed _.._ . <br /> - �--� �.---�-�----- - - - • - - -----------------••----...--- Owner <br /> BY ----------------------- -------------------------------------------- - _.--_------------- Title --........... • -- .............. ....... ............................. <br /> (If other than owner) <br /> DEPARTMENT USE ONLY _ <br /> APPLICATION ACCEPTED BY - --- . . ............... DATE <br /> BUILDING PERMIT ISSUED . _ -- -- _ -------------------------- ---------- DATE . •--- _._ .._-- -_- <br /> f <br /> ADDITIONAL COMMENTS . .. ..... .... . . <br /> ------------------ -- <br /> ................•----. ------------ - - • --- <br /> --------------------------------------••--------•--•-........--•-- - ------ ................... ............................. <br /> Final Inspection by: .:_ _ ­'A---- - Date ..TL. l� <br /> 2 �'= �` ........ <br /> Ell 13 <br /> � <br /> A <br /> _7/1bAQUIN LOCAL HEALTH DISTRICT S/?!, 3N1 <br />