Laserfiche WebLink
FOR OFFICE USE: <br /> FOR OFFICE USE: APPLICATION FOR SAN kTATION PERMIT �'.�� <br /> �.-- Perrnit-No.._..,----- <br /> (Complete in Triplicate' <br /> --- ---- --- ----" --- - Date Issued-- ---- �-�--7 �! <br /> ------------ <br /> --------------------------- ------- , _ <br /> �This Permit Eicpires 1_Year'From Date Issued, <br /> , <br /> ---------------- <br /> --------------------- '. z 3 <br /> the San Joaquin Local Health District for a permit to construct and.install the work herein described, <br /> Application is hereby made to Dance with Count Ordinance No. 549 and existing Rules and Regu at'�D <br /> County <br /> application is made in comp LL - - r CE TRACT---------------------------- <br /> This;, --------- <br /> us <br /> -- <br /> JOBADDRESS/LOCATIr <br /> N ------- Phone-.-._-.--- -- - - <br /> -- ------ <br /> ------------- — -- ------ ------------------ <br /> G✓ '' , , Zip <br /> -- <br /> Owner's Name------------ � ..�'-- - - - -- - - - N l City "--- =-- - _ 6'_/� ---- -- <br /> . - Pho <br /> ' �i -License <br /> Address---- - - --- - - - , <br /> .e -- - . -- <br /> ""- _ f. mmercia ra ler Court ❑ <br /> Contractor's Name.------- i' artment House❑ `Co` l s. <br /> Residence pk'T <br /> i <br /> will serve: -- ----- ------ g <br /> Installation; .�-�;• Motel � ,Other. : --- .. � ; --� - .-- - / - --- --------- <br /> . <br /> � x. `� <br /> ° �-.-_Garbage Grinder private <br /> .Size <br /> ` - - -._------:.------ --=--------- <br /> Loft <br /> 3 <br /> ' Number of living. <br /> units,_-;te and nameer of bedrooms. - i <br /> 1 Public Sys s F _T.,.- -- •- =, --- ( �- �: _ .. Clay Loam ❑ T <br /> Water Supply: t 5. Trr°= Peat❑ SaH <br /> a ndy L .am ❑ Y <br /> y - --- <br /> Character of soil to a depth of 3 feet: ^ Sand ❑ S`l�t� a elaa,l�ll 1f yes,type " <br /> t.. <br /> Adobe <br /> i Hardpan ❑ ; �1]/F i I` laced on reverse side.) <br /> F i <br /> showing size of lot, location of <br /> system in relation to'wellsi public is avabable within 200 feet,l / F <br /> NEWpINSTALLATION:' ,(Na septic tank or seep.agepitrperrriittedetc.-must <br /> p Liquid Depth..- /-��` <br /> a ;... k <br /> SEPTIC TANK ------------- ----- <br /> I PACKAGE TREATMENT ['1 <br /> Compartments.-_ -- <br /> Matarial. ---'E <br /> = <br /> Capacity - --- <br /> Ty F�}� n s/ --.Prop. Line_ <br /> O" dc�( n� <br /> d <br /> i Dista .ce to nearest: Well. 11, - = ' f - <br /> Fa .._ __ - __._ <br /> Length- # Beach_line1/16-Total <br /> tel Length...`- -- - - - - -- <br /> No..of Lines._ k -- <br /> LEACHING LINE: [ - -w- .__ '..� --- Filter. !. Depth <br /> �//,ry. '{te Material- - <br /> Box-_ ype Filter Material" _- i _ <br /> _.&�'T +� <br /> Line � ` � <br /> D _ rty <br /> - Foundation ` <br /> Prope <br /> k earest• Well.. ----� . es No <br /> Distance to n .. .. Y <br /> _ _ --- <br /> ' Number - <br /> iameter.- <br /> 9E51E Depth...-?.- k Siz - <br /> . <br /> .._ ._: - Roc - e'. - -_ -�`- <br /> me --------"-- -- <br /> .. <br /> • ._ Water Tabie Depth------------.-- --- -- <br /> R <br /> Foundation..-"- .Prop• L. <br /> Distance.to nearest: Well.. -- <br /> ---- <br /> €�- -" - -------- <br /> Date. <br /> ADDITION (Prev- Sanitati9 n-Pef�mrt# ; ------- ---------------------- <br /> ------------------------- <br /> REPAIR/ _..-.-_- -"------------------ - <br /> ecif Re uirements)-- = ! = -------------- = ------------ - <br /> t <br /> Septic Tank (Sp Y q; <br /> 1 ---- <br /> ------------------------------ <br /> Disposal Field (Specify gNuirer eints)�F----=_-.i- -- - - - - - --- - ------ -- -- -- . <br /> --------------- <br /> n, <br /> - <br /> -- <br /> r { - -- , <br /> i i----------------------- <br /> --- - - --- -= = <br /> --- <br /> - - - -- <br /> . "_" �- � (Draw existing and-required�add�ition on reverse side] ' <br /> I�cation and that thework- will -be done in accordance with San Joaquin°County <br /> ertf <br /> I hereby certify that I have prepared this app i <br /> Laws and Rules :and Regulations of,the San Joaquin Local Health District, Home owner or licensed ag <br /> Ordinances,' State , fy � } .- <br /> y person in such manner a <br /> signature certifies the following; t <br /> I that iri"the performance of the work for which this permit is issued; I shall not employ an p <br /> "1 certify . , . <br /> to become 'subject to.Workcmarrs. Compensation .laws of California." ' <br /> = <br /> - Owner <br /> = _:--=--:- -- <br /> Sign <br /> ; <br /> k <br /> Sign - -------------- <br /> ed <br /> l, other �' ownery <br /> Title <br /> -Sy ----------- <br /> By <br /> """ -- ------ ----------------------- <br /> f than 8 <br /> %F R DEP T' ENT SE ONLY <br /> . . <br /> ----------- ------------- <br /> ---- --DATE.--- ---= - � - <br /> - __ ------ -- :•:---------------------------- DATE - - --- ---- ---- --- -----=--------- ---� <br /> APPLICATION ACCEPTED BY.,-"==-- <br /> .-:. <br /> DIVISION OF LAND NUMBER.. - :------=----- ------- <br /> ---------------- -- --- <br /> ADDITIONAL CO ----------------------------- - ------------------ - <br /> -_-- <br /> ----- - - <br /> - __ j <br /> ----------- - /` <br /> i =--- --------------- - - - ` <br /> ------ w <br /> ---- ;--- - --------------------------------� Date=_ . - - ---- <br /> T --------------- <br /> ----- -- - -- 77 REV. , <br /> - <br /> Fin;l " -pec-------------------------------- <br /> - = ----JOAQUIN LOCAL HEALTH DISTRICT Fes 2�h 7�7_, SAN <br /> Final inspection Y: --- - -"`-" - - " <br /> EH 13 24 <br />