Laserfiche WebLink
FbR OFFICE USE: IAlt <br /> -APPLICATION,FOR SANITATION PERMIT. it No <br /> t Per <br /> ' riplicafe)-- <br /> .__ 6 <br /> - -._ (Complete m T q i <br /> Permit <br /> - --------- <br /> r; <br /> z�.. '� Date Issued <br /> This Permit Expires 1 Year From Date Issued <br /> --------------------------------------------------- _ <br /> l the work <br /> ealth <br /> rict for 6 <br /> it Jo c <br /> Application is hereby made to the San com liancecwial Hh Count, tOrdinan a Nom549 and ex s gnRulestand Regulation <br /> e�e1n <br /> described. This application is made p <br /> r « _ <br /> lQZ _..moo_ c ------ <br /> �OB A6DRESS/LOCATION .-��"' -- --�--/�`� --�'��----- -j�-""�'- - --�`-'�*zCl.�.�_-� --------CENSUS TRACT ----------- - <br /> r <br /> - ----- ne <br /> Owner's Name;- cx-----� r''"j " � P� <br /> -- ........ <br /> o <br /> '�' X' L ---------- City <br /> Address C� ---- _ '1. - -- <br /> �. <br /> -- <br /> Phone ------------------------------ <br /> License # ---------------� <br /> Contractor's Name .- ---- - ----------------------------------------------------- - - <br />` Installation will serve: Residence E]Apartment,House'❑ Commercial iilr' Courti❑ <br /> j Motel ❑Other ------------------------------------------- 9I t Size <br /> ------- <br /> Number of living units------------- Number of bedrooms --_-_- Garbage Grinder / - - I f ll <br /> r f--------Private ❑ <br /> Water Supply: Public System and name -------------- ------------------------------------ ------- ----(----------- <br /> L. <br /> r - -� <br /> Character of soil to a depth of 3 feet: Sand' Silt E] Clay E] Peat❑ Sandy Loam •❑ ClayLoam .0 <br /> - :� <br /> - f Hardpan ❑� Adobe ❑ Fill Material ............ <br /> ----"--"" If yes, type ------ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, tc.Wmus-be placed <br /> eet reverse side,; <br /> j � . <br /> p seepage pit permitted if public sewer is available within 200 ,) <br /> NEW INSTALLATION: {No se tic tank or <br /> SEPTIC TANK' --------------- <br /> Size ±� -----------• --------- Liquid Depth <br /> PACKAGE TREATMENT [ ] [ ] <br /> f ., -_'--- No. Compartments <br /> Ca acifi - Type -i--------------- - <br /> t p Y j t:., Pro Line ------ ---- <br /> 1 Distance to nearest: Well ------------------------------------Foundation -."-.-------- p• e 2 <br /> 'Len th of each Iline----------- ------{-------- Tata! Length ------•------ <br /> LEACHING LINE [ J No. of Lines ------------------------ 9 -: __ _ <br /> -_De Depth Filter Material --------- ----------------- <br /> 'D' Box __--____- - Type Filter Material "----------------• p <br /> '——--FOut) ----------- -_�:-Property Line ----------------------j <br /> Distance to nearest: Well ---_-- - _- <br /> I SEEPAGE PIT [ ] Depth Rock Size _-_ Yes ❑ No .0 <br /> Diameter--- ----------------Number ----------------:- Roc -Filled---- <br /> Water Table Depth ----_---------- I <br /> Foundation ----- Prop. Line ------_------- <br /> Distance to nearest: Well ------------------------------------- I : - <br /> --------------- Date ------------;------------ -) <br /> I REPAIR/ADDITION(Prev, Sanitation Permit # .------- ----"-- ; <br /> 4 �° �� -- ---- ---- -��------_-��-�-Vis=--- <br /> Septic Tank (Specify Requirements) -------- <br /> s �.--------------- <br /> ' Disposal Field (Specify Requirements) -"----„/ --- - �'`�'I�' t <br /> i ------------------^------------------------ <br /> -------------- , <br /> ., - --_-- <br /> t .f _ --".""_".__-:-"_•" ---------••----------------------------"-- -------- <br /> - <br /> -- - - -------- <br /> -------------- <br /> '. --------- <br /> ----------- <br /> . <br /> --------------.-••--.---_- - <br /> � - �(Draw existing and required addition on reverse sidel <br /> f 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 San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: permit is issue ' arson in such manner <br /> "I certify that in the perform of work for which this pd, 1"shall not employ"any p <br /> as to be4Z su e t o W s pe s of California." r <br /> k Signed --------------------- <br /> ---------------------- Owner <br /> ..�. -- T. -------------------------- <br /> By ---------------------- ----- Title -; --- ----"--------- ---------- <br /> ---------- <br /> �t <br /> (If other than owner) <br /> FOR .DE -ARTMENT USE ONLY • <br /> s..,T <br /> APPLICATION ACCEPTED BY -------- --- ----- 1- - --------------------- QATE --- �� ` <br /> -- -- -------------------- -- <br /> � _ _ _ DATE - --- . ---- <br /> BUILDING PERMIT ISSUED ----- -----------------------_ �= - ,' a--- ------ -i.:`_...:---------------- -------------- ----------"-- <br /> ADDITIONAL COMMENTS ----- � f!~ -� '-- -------- <br /> C -- l ---------- <br /> ----------------------------------------------_ .- <br /> ----------- . ------- <br /> ----- ------------------------------------ <br /> - - <br /> - ---- <br /> - - - - - <br /> Date " <br /> ' Final Inspection b ' <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT � ; �,26.73 <br /> T,R.D <br /> E. H. 9 1-'68 Rev..- 5M, t <br />