Laserfiche WebLink
FO 'OFFICE USE: APPLLf.A'TiON FOR SANITATION PERMIT <br /> {Complete in Triplicate} Permit No. ..7................ <br /> ..... ........................................ <br /> Date Issued . /� <br /> ..............._..............I..__..._...... This Permit Expires 1 Year From Date Issued <br /> ......... ...... <br /> Application is hereby mode to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This opplicatlon is made In compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS LOCATION -�_ � .__�.. 4 L .R] C.I~ 1:Q...................CENSUS TRACT <br /> Owner's Name L7� 7U'. L..:.. IL�1 .+�-? .......................--------------------------- ...........Phone ........ -----• .................. <br /> Address .........Pr.a.,-3px--------.1..:04.......... ------ --. Ci Nr <br /> ...._ ....................... �. <br /> Contractor's Name _.-..Q-W/k�-------.........................•-...........................License # ......................... Phone <br /> Installation will serve: Residence [F Apartment House C] Commercial OTraller Court 0 <br /> MotelE]Other ....................................•....... <br /> - <br /> Number of living units:......-.___ Number of bedrooms _-•.��___.._.Garba e Grinder..._._. � �� _._...... <br /> g g � lot Size ......_-•- ••__-- <br /> Water Supply: Public System and name ........................ ?---....----.--•----.--..._................ -Private <br /> ---------- --•----- <br /> Character of soil to a depth of 3'fee�:—Snnd tJ `'Silt�� CI Q-"�1' t f '"Sandy Loam O­Cray Lair -[i •-!rte--�-t <br /> Hardpan ❑ Adobe Q 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 revbrse side.) <br /> NEW INSTALLATION:, —No-septic.-tank or_seep a Tpit_pe�niltted-lf_pu6l cYsevrer is available within 200 feet,) /c <br /> PACKAGE TREATMENT SEPTIC TANK Size..... . .... . <br /> .� ................. Liquid Depth --•- <br /> ............... <br /> Capacity 12r . 4 r �✓No. Compartments ;.. <br /> ........... <br /> Distance to nearest: Well -------&42...................Foundation ...._. 0- f Prop. Line&,i;............. <br /> LEACHING LINE (p]/No. of Lines _._�............. Length of each Iin�Y�� Q � <br /> --�....�...... Total Length ....................... <br /> •D' Box _S._ Type Filter Material �''S� -...Depth Filter Material 11.. .........................__TOW), <br /> t ._... � <br /> Distance to nearest: Wsll...:........�....` .:: •Foundation ...:.1 - Prop6o Line .......... . d <br /> SEEPAGE PIT [ ) Depth .................... Diameter ............. NumBer�::,. . .............. Rock Filled Yes ❑ No { <br /> • Water Table Depth .......................Rock Size ..._............_.._... 611 <br /> f <br /> ...Foundation .._..... Prop. Line -•-.-_-- "�.._..... Q <br /> ;Distance to nearest: Well _________________••---........... ...... . ._. �" <br /> REPAIR/ADDITION(Prey. Sanitation Permit# Date <br /> Septic Tank iSpecifyTRe uirements) <br /> V­........... �.. ...... <br /> Disposal Field (Specify Requirementsi -----------R1-Vc5�Za____-.J.l�`T 47t}�`7�11�......P_/u. .... .:.......R: � <br /> tan <br /> f <br /> � 8 <br /> - <br /> T. <br /> ---------------------------------------------._----'--------- --------------------------------- <br /> -.._..--•------------- - <br /> (Draw existing and required addition on4ev'erse side) <br /> I hereby certify that 1 have prepared this application and that the work will be done In accordance with San Joaquin 7 <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquih Local Health District. Home owner or licew <br /> sed agents signature c rtifies the following: <br /> "I certify tha or once of ork far which this permit is 'issued, 1 shall not employ any person in such manner <br /> as to beco s o r man' en$ on laws of California." ; <br /> � t <br /> Signnee -_.._ ... .. .. .. . ....................................e <br /> CKner <br /> By .................... "' ...._.... . . <br /> ...... . <br /> T ............. <br /> ....... <br /> . ............ <br /> .............. <br /> ... <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY ! <br /> APPLICATION ACCEPTED BY .-----�/-R` ..................... .............. ....................... DATE .....: .:n..F-.7- <br /> BUILDING PERMIT ISSUEDDATE <br /> ��R ....................... <br /> ADDITIONALCOMMENTS ..... ................................... ................. •.................................................... :.._._........_. <br /> •---------------------•--------•-•-.----- ...........I ......_.__.............. • ........ ..........-....................__...------------•-•--- ------..__...__... ..... <br /> -• ----------------------- ------ •. ---- - - ------- -- <br /> Fibc+i,lnspecti . ..... ... . r ; Date :.........."./..7--�... rt <br /> . ...-- --------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H.13 24 1-'68 Rev. 5M 7/72 3 M <br />