Laserfiche WebLink
FOR OFFICE USE: APPLICATION FOR SAAITAT18N PERMIT �! <br /> )�. Permit No: -.-�� ---� <br /> --------------------- -- -- - (Camplete in Triplicate) Y� <br /> j <br /> Date issued __-i?-- y_2 <br /> This Permit Expires 1 Year From ate issued - <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> A <br /> PP le with County Ordinance No. 549 and existing Rules and Regulations: <br /> desrxibed. This.application ad is made in compliancI --- <br /> CENSUS TRACT ___-`�--5__f-----•----- <br /> r . -b-- +�-- -- ---------Phone--------------•------ ------- <br /> JOB ADDRESS/LOCATION -------01� <br /> ���-� ----- ----- - --- - <br /> Owner's Name -------- -------------- --------------g-31 <br /> .� <br /> � r <br /> ------------- -------------•--. City --- fLl�y- - ��- -------- ---------------------•------------••- <br /> Address ------------------. � __ -) <br /> , --- ---License # ------------------------ Phone ------ -------------•-------- <br /> _WA_IA <br /> Contractor's Name ---------------- artment House IDCommercial ❑ l❑ <br /> Trailer Court , <br /> installation will serve: Residence F] Apy ` <br /> Motel 1­14Dther ---- Mn�---------------- <br /> 2 Lot Size ------- -�------------------------ <br /> / Garbage Grinder �- ---- <br /> Number of living units:_-- f-_-_ N'mber of bedrooms ___ ____ Private [;J� <br /> Public System and name ----------------------------------- -------- <br /> -------------------------------------- R <br /> Water Supply: Y l Clay,Loam ❑ <br /> Peat Sandy Loam �❑ Y� ; <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ ❑ <br />' Hardpan ❑ Adobe'[.]'Fill Material ------------ if Yes,type ---------------------- <br /> f (Plotlan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) L4 <br /> P ; <br /> NEW INSTALLATION: (No septic' tank or seepage pit permitted if public sewer is available within 200 feet,) y W <br /> I Size ------ Liquid Depthz�_ <br /> PACKAGE TREATMENT [ ] SEPTIC TANK'[-J-" <br /> 1 <br /> Capacity --- --- Type �- � --- Material c1i�- __- No. Compartments ------1-; h1 <br /> .-�`�• _�-------- <br /> Distance to nearest: Well ------------------------------------Foundation <br /> ---- - - -------------------------•Foundation ---------------------- Prop. Line ----------------- ---- <br /> - --- - - -- - -- Length of each line----- -------------- -- --- Total Length ----------------------------- <br /> LEACHING <br /> ----------•---------------- <br /> LEACHING LINE [ ] No. of Lines g <br /> 'D Box ._ - -- -_Type Filter Material - --- --------------Depth Filter Materia <br /> n , = <br /> Property Line ----------•-•------ <br /> Distance to nearest: Well ____ - - -------- Foundation - ---- <br /> 1 , No 0 <br /> Number __-___ Rock Filled <br /> Yes [{]� <br /> SEEPAGE PVT [ Depth L+ <br /> ----------•Rock Size __fh- ---------- <br /> Water Table Depth --------- - -- ------- ----------- <br /> -- -------- <br /> Pro Line ------_------------- <br /> Distance to nearest: Well __--------------- - <br /> ----------- -------Foundation --- p <br /> ' ---- Date ----------------------------------j <br /> REPAIR/ADDITION(Prey. Sanitation Permit x# -------- <br /> -------'----- <br /> 5eptic Tank (Specify Requirements) ------------------------------------------------ <br /> Disposal Field (Specify Requirements ------------- <br /> -------------------------------- <br /> ----------- ------- ------------- ------------------ <br /> ---------------------------- --------- <br /> - ----------------- <br /> q ------ -- -- F <br /> - {Draw existing and re wired addition on reverse s� <br /> me in accordance with San Joaquin <br /> I hereby certify that I have prepared this application and that the work will be do <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: arson in such manner <br /> "I certify that in the performance of the work for which this permit is issued, I shall not employ any p <br /> a�to become ubject to Work Compensation laws of California." <br /> Sign -- --- ---- ------- ---- <br /> ------------- ----------- Owner <br /> - - -- <br /> -------------- - <br /> -- Title <br /> ------- ------------------------------------------ <br /> ------------- <br /> ------------------ <br /> - - - - -------------------- - - <br /> {If other than owner) <br /> FOR DEPART ONL <br /> -------- - -- <br /> DATE --.7/--- 77- ------ <br /> --------------- -------------- - <br /> APPLICATION ACCEPTED B .___------------------ - <br /> - - -------- ---------- ------ ----- --- --------------------- <br /> BUILDING PERMIT ISSUED ----- -------------------------------- --- -----• <br /> ADD{TIONAL COMMS ---------------------- - <br /> --------- --------------------------- <br /> - ------------------------------------------------------------- - - ------------------------------------------ ---- <br /> «_�� <br /> ----- -- ----- <br /> -- --- --- -- -------------- <br /> j� Date --- <br /> --- --- ---- --- ---- U"` l <br /> Final Inspection b --------------------------------------------- ---------- <br /> SAN JOAQUIN LOCAL HEALTH D1 ICT <br /> r u 0 1-'68 Rev. 5M <br />