Laserfiche WebLink
FOR OFFICE USE: J. <br /> APPLICATION FOR SANITATION PERMIT <br /> PermitNo. .. 3...... ` <br /> s <br /> ..................................... 4�j(Complete in Trtplicate) <br /> .... . .. ................... Date Issued ....__....._....�.� <br /> This Permit Expires 3 Year From Date Issued N z! _2-1 0-LI <br /> 1: <br /> Application is hereby tirade to the San Joaquin Local Health District for a permit to construct and install the work herein. <br /> described. This application is made in compliance w' Caunty„O;dina^c{ No.Y54q and existi g; Rules and Regulations: <br /> �22SSs - ' v c c ...�TR CT���i <br /> JOB ADDRESS/LOCATION ,...1..........-t,_..__ _ _ 4 F <br /> Phone ' <br /> 16” is .Name � ... ((all. ........,l :IL.�. <br /> � .. .. ._ .License'#��,r.��.�. Phtini3' t�►.�- �� <br /> ' .r's'Name . FCS ; <br /> Con'ttacto •••- <br /> Installation will serve: Residence: partmerit-HouseO Commercial TrailerCaurt ] <br /> _ Motel <br /> ! !Garbag e Gender. Size- !a j <br /> Number of living units:. . Number.of. bedrooms ._ _.Ga .b.g <br /> Water Su i Public S stem and name - x" <br /> Clay Loam_Q i <br /> Character of soil to a depth of 3 feet .Sand n Silt❑ Clay ❑ Peat❑ Sandy Loam <br /> dobe Material _ If yes, type 4 <br /> { Hardpan A _ <br /> a <br /> (P[ot,;.plan,. showing ,of..lot,,,location,of:.system in .relation to.well', buildings, etc. .must..be .placed on.,rexerse;.slde,1,, <br /> NEW:INSTALLATION: , (No septic:tank or iseepage pit perrimitted if spubiic sewer is available within 200 feet,I <br /> Liquid.Depth <br /> PACKAGE TREATMENT [ ] SEPTIC TANK: ,] e r�', <br /> r' + 1C e V.-'J. JMaterialxc-Fc o.~ Compartments �� <br /> ! . Capacity YP <br /> III d <br /> Foundation Prop. Lin <br /> F Distance #o nearest: Well .___.r .j ••• T' +• <br /> _�..e._... <br /> - -- — - �� �=L 9 line Total ner <br /> ` No. of i fries .. <br /> LEACHING LINE ` [1� �..... .......... <br /> Len <br /> th of. a <br /> Type Filter Mate <br /> Filter Material <br /> _ <br /> r. 'D• 138x . /t j r <br /> Distarste to nearest: Well ..:.. --� -- Foundation -..._. Properiy. Line ' <br /> [yj' Depth. .. D'+ameter .`f.. Number ----: ' Rock Filled Yes .[ --�Vo' <br /> SEEPAGE PIT - ?1"�'` <br /> Water;Table Deptli.. A- •s- -- .Rack Size.-: / <br /> Distance to nearest. Well atlon qp•. <br /> Found 1. Pe ine <br /> j... . <br /> -------: Date <br /> R�t'AIR/ADDITION(Prev. Sanitation Permit • - <br /> Septic Tank (Specify Requirements)p �Y ;., <br /> q <br /> e . <br /> _. . - - , <br /> - ..{ pecify R ments) <br /> # Dis'posal Feld 'S quire ,. <br /> t ... . -- <br /> ------- <br /> side) <br /> - • ... ,_..,.. ^„5 {Draw existing and required additmn on reverse s' , ,,,, ..,`•�..,t x,.,,-.. �' ... ;.<_... ' <br /> I thereby certify that I have prepared this application bind Ghat the work will be •done m:actnrdanca with San Joaquin <br /> Coktnty Ordinances,'State Laws"arid Rules'and Regulations of the`San Joaquin'Locgi Heaith District ,Home�awner Or I+cen <br /> i sed agents signature_certifies the fallowing. ;. • ,b..' <br /> °'I certify that in the perfarmarice of the work for which this'permit is issued, I shall no <br /> employ any parson In such manna* <br /> as to beco'ine sub'ect"to Workman s-Coin ensatiori' laws of Colif <br /> .k OWner ; <br /> St�iled rr' �{ <br /> B' <br /> i (If other ha owner) <br /> - VOR';DEPARTMENT USE ONLY s <br /> APPLICATION ACCEPTED BY <br /> PERMIT ISSUED T <br /> j f <br /> ... <br /> _ .. .: DATE <br /> BUILDING <br /> ADDITIONAL COMMENTS ' <br /> .. .. __.......�..-- .... _ 3 4 _ <br /> - {. - S __ S 6 2 S ' -Date - .. -- -fl' <br /> Final Inspection by: ;: ' <br /> ' SAN JOAQUIN LOCAL ,. a .._ . <br /> HEALTH pISTRICT <br /> 7/72 3 M <br />