Laserfiche WebLink
i FOR OFFICE USE: "a- <br /> ��, ��.,,-APPLICATION FOR SANITA iON HERMIT <br /> y Permit <br /> -.l ------ = """ ..- r <br /> , . (Complete in Triplicate)= <br /> --------=------- <br /> - - Date Issued <br /> + This Permit.Expires 1 Year From Date Issued <br /> I Application is hereby made to the San Joaquin Local Health District for a permit to construct and insfiall the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing R Ids and Reglullaatiio�ns: z <br /> - ---- NSUS TRACTS. <br /> JOB ADDRESS/LOCATION .- �--- CS-F /''u .- ------ <br /> r. <br /> Owner's Name ----Ll�.-S '-e�` C.. --P- - ��� i.-�P _ --�-----------Phone -------------------- <br /> ______________ry[- I <br /> Address . `��' •----------------- ------ City ------S �C� TO_h--:------------- ---------------- <br /> -------------- <br /> ----------•---- 7 <br /> --- <br /> �+ Y. License # Phone - �_G•'__D7. .. <br /> Contractor's Name ------C. = ^� 0_�<�1� <br /> Installation will serve: Residence gApartment House❑ Commercial:E]Trailer Court i❑ �, <br /> Motel ❑Other ------------- ------------------------- <br /> Number of living units:----/_----- Number of bedrooms ---I-------Garbage Grinder --- Lot Size -___--/0----- - _R 6\ <br /> /� A ------------Private ❑ x <br /> Water Supply: Public System and name _______________L!!-- �I---•--.-----� --��- - <br /> Character of soil to a depth of 3 feet: Sand'❑ Sift❑ Clay ❑ Peat❑ Sandy Loam ❑ . Clay Loam:❑ <br /> Hardpan ❑ Adobe )V­ 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 reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage_pit perr i iedl pkbblivawer Wa&iYdble within 200 feet,) C <br /> PACKAGE TREATMENT [ ] ESEPTICTANK![ I Size------------- :---- = f--- Liquid Depth _-_--- ----------------- <br /> Capacity 1�' d-- --- Type -------------- <br /> Dista' <br /> --------- Material pz� No. Compartments <br /> Distance to nearest: Well ri1.0. ------------------Foundation _---s _gy----- Prop. Line .' �__.------ e <br /> i. ....w���.�-- .//' .------ Y. / <br /> ff�/ .. _''.... <br /> LEACHING LINE [ ] No. of Lines __ -/ Length of each line__ Y�___`l �-.V(� Total Length :_- �i d <br /> 'D' Box ---k----- Type Filter-Material _��x�l�_�ct##pth Filter r Material -----1_-9_-��-------------------------- <br /> - f r O <br /> } Distance to nearest: Weil _df-CLQ__________ Foundation 3 ------------------ Property Line ___-____-_-- <br /> SEEPAGE PIT Depth -- Diameter ---------------- Number .--------- ------ Rock Filled Yes ❑ No <br /> [ Water Tdble.Depth...:---- -------- --------`=---- -----Rock Size --------------------------------- <br /> Distance to nearest: Well ------------------ -------------- -.Foundation -------------------- Prop. Line -----------.---------- <br /> • i r <br /> REPAIR/ADDITION(Prev..Sanitation Permit# --------------------------------- ----- Date ----------------------------------) <br /> Septic Tank [Specify Requirements) ------------- -------------------- -----------------------•---- <br /> Disposal Field (Specify Requirements) ____----_-__ --------•----- ----- <br /> ----------------------------------------------------------- <br /> '`(Draw existing and-required addition on reverse side)., <br /> I hereby-:certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br /> 11 <br /> County Ordinances, State Laws, and Rules and Regulatioris of the San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify that in th perf ante of the work for which this permit is issuedr I shall not employ any <br /> person in such manner <br /> as to becom lett to orkmat�s Compensation laws of California." �c 7- <br /> Signed ;. `� ------�---- Owner <br /> 7 1 <br /> - ----- Title --------------- ---- ----------------- ------ ---------------------- <br /> (If other than owner) <br /> FOR .DEPARTMENT USE ONLY <br /> Or APPLICATION ACCEPTED BY __ DATE -- ----Z- <br /> BUILDINGPERMIT ISSUED --------------------- -------------- -------------------------------------------------------------------DATE -------------•------------------------•---- <br /> I ADDITIONAL COMMENTS ------------- --------------------- <br /> -- ______ _______ _ - -:_-__ -____ - . -------_______--- - -_-:::__ -_-__- ------------------------ _`f ----------- <br /> Date : ::_:_ -_ _:::__:__ <br /> _ _ --- - - <br /> Final Inspection b � ��f � - <br /> P y: ------ - --------- -- - -- dtf'rte_' <br /> SAN JOAQ IN:,.LOCAL HEALTH DISTRICT <br /> ( _ 0, <br /> I/ H. 9 1-'68 Rev. 5M <br />