Laserfiche WebLink
I <br /> FOR OFFICE USE: ,�., <br /> APPLICATIOI`Vr ORIANITATION PERMIT <br /> - ------ <br /> (Complete in Triplicate) Permit No. <br /> ---------- ----------------------------------___________ This Permit Expires 1 Year From Date Issued <br /> Date Issued <br /> Application is hereby made 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 With County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION ------ Lw-m-a-pr)---------- __/=#R -------------------CENSUS TRACT s5_a_-----..--------- <br /> Owner's Name ---------------1 n t bej,5�.t�J4::>-----!_�S---------------------------- -------Phone --------------•--------------------- <br /> Address ----------------------- L1A-_LP14-t�----Ro-------------------------------. City - ---- -------------------------------------------------- -----------.._-.-- <br /> Contractor's Name ---------------------f-'-tjr---+ --.3ru'e'J------------------------------------------License 902,30--Z---------- Phone <br /> Installation will serve: Re--silence [?rApartment House❑ Commercial :❑Trailer Court ❑ <br /> Motel ❑Other ------------------------------------------ <br /> Number of living units:-__ __-__ Number of bedrooms _______Garbage Grinder _--— Lot Size --------------------------- <br /> Water <br /> ---______________________Water Supply: Public System and name ----------------------•---------------------------------------------------------------- ----------------------Private <br /> Character of soil to a depth of 3 feet: Sand'[-] Silto Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam .0 'V'AA0Cx . <br /> Hardpan ❑ Adobe ❑ 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 permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK Size------------- Liquid Depth ___Y�_____________ <br /> Capacity �_�1 _______ Type - � ---- Material--- "' ___ No. Compartments __z-__-_-_-_---- <br /> Distance to nearest: Well -------5--f----------------------Foundation ---/0_____________ Prop. Lincce .a�$.. ------ --- '+ <br /> LEACHING LINE [ ] No. of Lines ------ _______________ Length of each line-------20------ ---- Total Length _A��_ __---__-__---___ <br /> 'D' Box ViS___ Type Filter Material, ?_ _---Depth Filter Material ----� _ ____________________------- <br /> ___ <br /> I <br /> Distance to nearest: Well ------ Y------------ Foundation ---&D-------------- Property Line ---37-1 <br /> ............. <br /> SEEPAGE PIT [ ] Depth ___ _______________ Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No 0 <br /> Water Table Depth ------------------------------------------------Rock Size -------------------------------- <br /> I <br /> Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ---------------------- <br /> REPAIR/ADDITION(Prev, Sanitatiorn Permit# --------_----_------_----------------------- Date _--________________-__--__________) <br /> Septic Tank (Specify Requirements) ---------------- --- -----------------------------------------:-----------------.--------------------------- <br /> I <br /> Disposal Field (Specify Requirements) ------------ ---- -------------------------------------------------------------------------------------- <br /> ------------------------------------------- --------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> I (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 /> 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: <br /> "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner <br /> as to bsu Iec to Workman's Compensation laws of California." <br /> eco <br /> Signed -- ------- ------------------------------------------- Owner <br /> By ------------------ -------------------------------------- -- ----------------------------------------- Title ---------------- <br /> (If other than owner) <br /> FOR DEPAit7 T ON <br /> APPOCATION ACCEPTED BY ------------------ --------- ------------- --------- - �►--------• DATE f/-.. ��I( ------------------ <br /> BUILDING PERMIT ISSUED ----------- ------------------------- ----------- ------------DATE ------------------------------------------- <br /> ADDITIONALCOMMENTS ------------ -------------------------- ----- ----------------------------------------- ----------------------------------------=--------------------------- <br /> - -------- ----------=------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------- <br /> a <br /> ------------------ <br /> FinalInspection by:-=---------------------- I---------------.-------------------------------------- -----/RI <br /> ------Date --------------- <br /> SAN JOAQUIN LOCALHEALTHDI <br /> E. H, 9 1-'68 Rev. 5M <br />