Laserfiche WebLink
FOR OFFICE USE: r ATION PERMITFOR OFFICE USE: <br /> APPLICATION FOPSAIJIi� ` �7 <br /> �'�^'� Permit No-----7-?_------------ ---- <br /> .: - <br /> (Complete in Triplicate) <br /> /f1-7_7 <br /> .. --'--- ------' Date Issued---------------- <br /> This Permit Expires 1 Year From Date Issued i <br /> Application is hereby made to.the San-Joaquin, Local_HealthrDistr_ict for..a_permit_to_constxuct and. install,the work herein described. <br /> Thi application is made in complioncewith County Ordinance No. 549 and existing Rules and Regulations: <br /> - w <br /> -- ;• I <br /> JO ADDRESS/LOCATION:.._. !,ion R C� - ��e 1--. CENSUS TRACT_ ___________________ _____ <br /> - ----- ---------- "€ <br /> i " .+� e S : r�� S l e '_ [ F Y I t ] ----Phone_. --9---.�J.x ,�.. <br /> Owners Name,100� T�-___ ._ -- <br /> r faf� C/�3-T�c i� Ci 1 T3� 'Z p: S33 G <br /> ' ess.------��- - ------ tY <br /> Address----- - � <br /> r �- <br /> Cont'.rocto's.Narme_.._�__-. o 'i s`htV �---- --License-----_P ��.::- Phone <br /> s a i ve_......T.,r,.,.�_.�...._...... .. i <br /> Installation will serve: Residence Apartment Mouse. Commeraal Trailer Court ❑ ! <br /> ( Motel Other----------='------'=- --- --=-_` <br /> Number of living units:------ --------Number of bedrooms_-.-----Garbage Grinder-----------Loi Sizer-_._'----------------------------- <br /> Water Supply: Public System and name ------- t-- ------------------------ -_ ---------------., _ t ' ._ Private <br /> Character of soil to a depth of 3 feet: Sand] Silt❑ Clay ❑ Peat❑ Sandy Loam]- Clay Loam ❑ <br /> If es, e__ f <br /> Hardpan ❑ ' Adobe•❑ Fill Material____._ �s�,,-------------- <br /> Y type -----' „ .l <br /> {Plot plan, showing size of lot, location of system in relation to wells, 'buildings,-etc, muste placed on reverse s'ide.] <br /> NEW INSTALLATION: .(No septic tank�or seepage pit permitted if public sewer•is avd+lable lw <br /> ithin 200 feet,)' <br /> PACKAGE TREATMENT SEPTIC TANK - - ---.-Liquid ' <br /> Depth- --------------------- <br /> Capacity <br /> --. _____---_ -____ 1 <br /> - � <br /> Well '� �_�.Foundation !_ Compartments ----- <br /> .0000- <br /> Distance <br /> Capacity- :Type----- ------= Material - -- <br /> Distance to nearest: --------Prop. Lin ------------------------ <br /> Fr <br /> ,L-EACHING LINE (�] No. of Lines._ . :__'._.'Len th of each line �_ ___ --------------- __Total Length __ ------------------------- <br /> € 'D' Box__- --.r-Type Filter Material---------_.______-__Depth Filter Moterial __ ---------------------------------------------------------�`1 <br /> _ A <br /> Distance to nearest:,Well__------------ ------------ <br /> ----- --Foundation_.____. _Property Line________.___._____.____------- - _-, 1 <br /> SEEPAGE PIT [ ] Depth---'-------- <br /> -- Diameter-------- ------ Number---------'-----`°-�- ------�`_ R;�cci�Fiil Yes E] No ❑ <br /> f t Water Table Depth -------•------=-----Rock!Size---- s <br /> w Distance to nearest: Well._ -------;----------- --------Foundation-------------- F----- .Props i ------------------= <br /> •.REPAIR/ADDITION {Prev. Sanitation Permit#-------------•--------:--- -- ---- Date-----_- •_----------------------------- -- ] <br /> i 'Se'ptic Tank [Specf ----------- - ----- ----------- <br /> z <br /> Disposal Field (Secify Requirements]-.�-' T�C_ .,_,( M _ 7�_-___ �p_Q_ i____�� �+ ;_f�� l__ ----------------------- <br /> pC' <br /> ; f l zt f �` ----' - --------------- <br /> E --------------------------------------------- -----`------"'-"_-.-- "-- ---"------- -- ----- _-"-- - ------ _ <br /> -------- <br /> "i <br /> __ _ ___ -`YrJf <br /> k ___`. __._ ______ _ ________ _____________ ------- _.___ _���- __ f <br /> , - <br /> (Draw existing and req • adclition_on rea isses'r e <br /> 1 hereby certify thlat I have prepared this application and that the work will•be done in accordance with So aquin County <br /> Ordinances, State Laws, and Rules and Regulations of the San Joaquin Loial Health District.?Home owner 'r,licensed agents <br /> signature certifies the following: <br /> "I certify that in the performance of the work�or which-this permit is issued f,l shall not employ any pers n such manner as <br /> to become subject to Workman's Compensation,laws of California." <br /> Signed11fj/S_Gl➢�f.� -----=------- ----- -----------.;Owner °. <br /> t <br /> xZ Title----- �.— --- € <br /> BY <br /> Oe;r­446n <br /> owner) - b <br /> - FOR DEPARTMENT USE ONLY y ` <br /> AP' LICATION ACCEPTED BY----- Cit - -- - - - ------------------------------- -------------------- DATE ---- -77----------: <br /> DIVISION OF LAND NUMBER-------------- ----- DATE.: <br /> ADDITIONALCOMMENTS------------------------------------------------------------------------------------ ---------=------------------------------------------­-------- ------------- ------ ; <br /> t ------- - ----------- ------------- <br /> ---------------------------------------- - --- ----- --- <br /> s <br /> --'-------------- ---•------------ --- -- -- ----- ------­------- <br /> -------- <br /> ,.. 4 -- -�- _ ------- - ------------------ <br /> b <br /> ---- -- ---- <br /> Final Inspection by - !� u--` - - <br /> =------ � - -- ------ -- 7 <br /> 1. ` Date --- S <br /> • &5 21677 REV. 7176 3M �1 <br /> c�i 13 24 - SAN JOA UIN IOCAt FiE;4LTd-I-�RISTRICT � ;, <br />