Laserfiche WebLink
t. F <br /> FOR OFFICE10SE: APPLICATION FOR SANITATION PERP <br /> ' 1 Permit No. f= <br /> (Complete in Triplicate) <br /> ---------=------- ---- ---------------------------- <br /> r. Date Issued <br /> ------------- This permit Expires 1 Year from Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a per tee construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 54911and existing Rules and Regulations: <br /> JOB ADDRESS/LOCAT `R <br /> ---------------- ----- --- CENSUS TRACT _"` �_---- <br /> i4 <br /> Owner's Name `" 11V Phone <br /> --� - --- -City f. 4 ---------------=------------------------------------- <br /> Contractor's Name _1------A_N-r"t447�_Ix © -----------------------License #16,6-5ff --- Phone S_�L _ _7. -, <br /> Installation will serve: Residence ❑Apartment House f:]Commercial Vrailer Cou—t ',❑ <br /> Motel ❑ Other Rpm14-__@_Ft_c ___ xp PrNs o- <br /> a "". 5 <br /> Number of living units:__.'=._ Nu bei-of bedrooms ,___"" ___Garbage Grinder ____.__..__ LotSize ----••------ <br /> Water Supply: Public System and name -------------------------=-------------------------------------------------------- ---------------------------Private <br /> Character of soil to a depth of 3 feet:.r, Sand'❑ Silt f] Clay .❑ Peatandy Loam; Clay Loam E]ZHa dpan 0 Adobe 0 Fill Material 191'__ If yes, type ___"_""". ____""-._-___"" <br /> (Plot plan, showing size-of lot, location of system in3relation to:wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit',pe'rmittecl,jf public sewer is available within 200 feet,] v0 <br /> 1 <br /> PACKAGE TREATMENT f J SEPTIC TANK Size.___lf _l --------- -------- Liquid Depth <br /> -- . � __ _ ___r____'____--______ <br /> Capacity Type -�-EU4ST--Material�NCP\F-jF-_No. Compartments ------•-------------- <br /> �4 <br /> - <br /> Distance to nearest: 'Well ------ ;�_____________Foundation --119------------ Prop. Line ___- ------------- <br /> LEACHING <br /> ----'"-_.___LEACHING LINE No. of Lines ------ - :__- Lengthof each line___1D_O-"------------- Total Length ,___ ._..__.__.. <br /> Box _ Type Filter MaterialrP_©_C�_Depth Filter Material ______"� -------­-------------------- <br /> 'D'Distance to nearest. Well --- �� ---------,Foundation _.��-- ----- --- Property Line __ .. `-•.•.- <br /> SEEPAGE PIT [ ] Depth "£" _ Rock Filled Yes No <br /> ------- Diameter.--------------- Numbe, - _ - ❑ ❑ <br /> x <br /> Water Table Depth --------------- _.:--------------Rock Size ----- <br /> '"` �_ -------------------- <br /> { __._._Foundation _-._w <br /> ® Distance to nearest: Well ---------Y------ -.---. Prop. Line --------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ----------------- = -----"--=---_---- Date ------------- �-------------------) <br /> f, '-4 L) \ - <br /> Septic Tank (Specify <br /> !VD_ Requirements) -- -__P_V ----- <br /> IV -- <br /> 4 <br /> Disposal Field (Specify R quiremen-ts) �JN4-5----------3-6--------WI_�---------------------------------------- <br /> Roa4Dl3a1,1_lChl./V----------- <br /> ----------- <br /> ------------- - <br /> ----S.-----------i- ------------------------ ' --------------------------------------- -------------------------------------------------------------------------------------- <br /> 4,(DFaw existing and required addition on reverse side):, E <br /> I hereby certifyy at I have preparedhis application and that the work will be doe in accordance with San Joaquin <br /> County Ordinances, State laws, olid Rules and Regulations of the San Joaquin Local Health District, Home owner or licen- <br /> sed agents signature certifies the following: i;J <br /> "I certify that in the performance of the work for which this permit is issued, I shall ';otremploy any person in such manner <br /> as to become subject to Workman's Compeniati.on laws of California." V <br /> Signed . fgNT -n/1/ (---'---- _�?-o_Ai <br /> '--------------- Owner %r <br /> BY <br /> 1 <br /> ----------------------------- <br /> ----- c <br /> D------- Title ---------------------':: <br /> (If <br /> other than owner) I <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED—BY _=0r---------------- -----------------------== '-------- ---------------:DATE -----f " ..- /--------- <br /> BUILDINGPERMIT ISSUED -----------'-------------------------------------- -------------•------------ ------------=--- -------DATE ---- -------------------------------------- <br /> ADDITIONALCOMMENTS /1 --------------------------------------------------------------- --------------------------- <br /> -------- ---------------------------- f------- <br /> �---- - C•C �-' ';`r----- ---- ',--�-------------- - -- --------- <br /> ,� 1 _� ------------- ----- --------- --------- ---- <br /> ___ _ _____________ ___ _ ___.___. .. _ 4.__ <br /> Final lnspecion-bye_ - --- = = = Date _.- a;. _ <br /> SAN JOAQUIN LOCAL HEALTH DISWC! <br /> E. H. 9 1-'68 Rev. 5M <br />