Laserfiche WebLink
FOR OFFICE USE: gppLICATION �03t SANITATION P�RM1T <br /> Permit No- __" -----�./�S <br /> ' ------- ----- ----------------=----------------- (Complete in Triplicate) <br /> --- p Date Issued --- l "7.=-7i- <br /> This permit Expires 1 Year Front Date issued <br /> it to construct and <br /> l the work <br /> rein <br /> Application is hereby made to the San Joaquin com lion ecwiHh Countyealth District <br /> itrice foOrdinance Nom549 and ex a. per sting Rules tand Regulations- <br /> described. This application is made i 1 <br /> IISG-QT1 CENSUS TRACT --- - � ; <br /> JOB ADDRESS/LOCATIO --- <br /> _ ----- ------ -Phone ------------------------------------ <br /> Owner's <br /> -------- -Owner's Name ---" <br /> _L FSCAt�C? ---------------------- <br /> Sti� Q►�[-_" TTA_ --- City --- <br /> Address ----------- ------ ' <br /> Phone ----------------------------- <br /> Residence <br /> ----- ------- -------------- <br /> ----- --- ---- ----- ------------=--------License # ---------,, ----- -- <br /> Contractor'shame -.-._-__p-���-�-------------------------------------------------- <br /> ---- ---- - - - <br /> lnstallation will serve: Residence partment House-E3 Commercial ❑Trailer C 4 rt 'Cl <br /> Motel ❑Other -------------------- -- -------------- ' + <br /> e Grinder __ --/ Lot Size -� <br /> Number of living units:".------- Number of bedrooms __3_------Garbs 9 f <br /> ------------------------------------------Private <br /> - --- --------------------- j.+: _ .-. <br /> Water Supply: Public System and name_ ___""-_"------------------�------• ---_ .. -'y Clay Loam s <br /> Silt,.0' Clay ❑ Peat❑ Sand Loam 0 <br /> Character of soil to a depth of 3 feet: Sand'❑ <br /> -------------------------- <br /> ` Hardpan dobe ❑ Fill Material 1K ---- if yes, type -- x <br /> )Plot plan, showing size of lot; location ofasys em in relation to wells, buildings, .etc. must be placed on reverse side.) f� <br /> # <br /> it permitted if public sewer is available within 200 feet,) <br /> NEW INSTALLATION: {No septic flank or seeps P p t � <br /> Liquid Depth <br /> ----- --- `"` <br /> SEPTIC TANK Size"_ - Liq p �l <br /> PACKAGE TREATMENT [ ] _ _ _ <br /> © ptC}}S'�Mf gteria"CRTrNo. Compartments ;f <br /> Capacity,, � _ ------ <br /> _7Type -- ------- t � ,.. <br /> p ty - i <br /> _ �- --- Pro Line --- J� <br /> istance to nearest: Weli �J`1 -------- Foundation <br /> LEACHING LINE [ No. of Lines _ -a---- <br /> _ _______Length of each line.-_�E�`7 Total Length�r-" <br /> ------t---------- <br /> p' Boxype Filter Materials-GYM"_-,Depth Filter Material "-_�- ------- _-1- <br /> .�- <br /> �` �f---- Foundation �� Property Line ------------• <br /> I - <br /> Distanceto ne�rest:Well--- - ------ <br /> f �f- __ =--.-Number- .-----*Z °- --- Ro/Fill yes•�No C <br /> SEEPAGE PITDepth -------- Diamefier Water Table Depth ___---Rock Size " - _-- ------1a--`� "" rop _L•ine .__S] <br /> Foundation <br /> Distance to nearest: Well _"-."�Q��•--- - �. ..•-- <br /> -- ------- <br /> REPAIRfADDITION{Frau. Sanitation ermi -------•----- - f <br /> I. ------------------------ <br /> Septic <br /> ---------- i = <br /> Septic Tank (Specify Requirements) ---------------------------------------------------------- <br /> _".""_.._.-__-_"------------------------------`---.__`-___-_ _!" _---"_-"--_-""_-.--"""__".r"".. <br /> Disposal Field (Specify Requirements) ----_------ <br /> f ----------------- = ----------- .. -------------------- . <br /> r (Draw existing and required ad--------------------------------- - = I, w <br /> dition on reverse side). <br /> ul <br /> I hereby certify that I have prepared this applicationdtof the 5 n Joaquin Local Health District. Ho owner or liken- <br /> hot the work will be o <br /> County Ordinances,`State Laws, and Rules and Regulations <br /> sed agents signature.certifies the following: ermit is issued, I shall not employ any person in such manner <br /> "I certify that i the p ormance of the work for which this p <br /> as to beco bjecf orkma s pens on laws of California." �. <br /> c. Owner <br /> Signed --. <br /> - _ --------------------------- <br /> _ Title ------------ <br /> (if other than owner) <br /> FOR DEPARTMENT USE ONLY --- <br /> t - 1 ft� !> <br /> i. DAT "- /- -� <br /> APPLICATION ACCEPTED BY ---- 'l ' = __ _---- - =:._ =- _ ��.>i1►� <br /> BUILDING PERMIT LSSUED ------ �� -------- -------------- ----------------------- ----- I5ATE -_ -- - 1 <br /> ADDITION L-CO `rA S- _' " _ -. P R/3 17`:-7 �`� _ �-- - __ <br /> / Y <br /> --- -- 4 <br /> -------- -=-�-"`=------ "Date --- ----------•-- -------------- <br /> Final Inspectio <br /> SPAN JOAQUIN LOCAL HEALTH DISTRICT <br /> WA-5 e�� ��A, P { <br /> l/fE;7AL"tF� AS SROl.<.W 14 BE—:F0R� PE-rf3M 1-r— <br /> E. H. 9 1-'68 Rev. 5M <br />