Laserfiche WebLink
FOR OFFICE USE: <br />.. ........................ .............L........ I APPLICATION MR SANITATION PERMIT <br /> .... fPermit No <br /> . (Complete In Triplicate) <br /> ............................•----•..............'..:...... <br /> . 4� <br /> Dot6 Issued .. ... . <br /> T Ives I Year From Date Issued <br /> ......................... ....... his Permit Expires <br /> Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work Grein <br /> described. This application is made in compliance with County Ordinance o. 549 and existing Rules and Regulotion.s- <br /> 'b <br /> Zll .....................CENSUS TRACT ...... <br /> JOB ADDRESS/LOC CIN ...J.74 ....0­1�........ <br /> Owner's Name --- <br /> ................................, ..Phone .,01� <br /> Address --------- ..........city .... ..................... <br /> e <br /> Phone ..........K?1�45 <br /> L -�W...7 <br /> Contractor's Nome . ...4 IrA.L.-License <br /> Installation will serve: Residence KApartment House 0 Commercial OTraller Court 0 <br /> Motel 0 Other............................................. <br /> Number of living units:_ ...... Number of bedwoms .2.-Garbage Grinder ....[...... Lot Size ....... <br /> Water Supply. Public System and name ..........41t .64Q. .......-1.............................................­­..............Private 0 <br /> Character of soil too depth of 3 feet- SandE3 Silto Cloy [j Peato SondyLoam o Clay Loom m <br /> Hardpan E3 Adobe 0 fill M6teriol ............ If.yes,type ............... ............ <br /> lot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse *ids. <br /> NEW INSTALLATION: (No septic tank or seepage pit Te If gpbllc sewer is ovoilowithin 200 feet,) <br /> 7, <br /> PACKAGE TREATMENT SEPTIC TANK Size630...O.A-iL_ Liquid Depth .... ............... <br /> Copocity/2do......... Type 0k, 4a.,Aaterlal------_.............. No. Compartments ...................... <br /> Distance, to nearest. Well .......ha......................Foundation _4p -------- Prop, Line ... ............... <br /> LEACHING LINE No. of Lines ......I................ Length of each ............ Total Length <br /> .... ..................... <br /> D' Box Type filter Material Depth Filter Material ..ZF.................................. . <br /> Distance to nearest: Well ....?R_ .......... Foundation ... Property tine 10................ <br /> SEEPAGE PIT Depth ... <br /> Diameter 19 .. Number �..................... Rock Filled Ye J No (3 <br /> Water To'ble Depth .Rock Size A? ................. <br /> Distance to nearest. Well --- ..............................Foundation JZZ....... Prop. Line/A........ <br /> REPAIR ADDITION(Prev. Sanitation Permit# ........................11-1................. Date ................ .................. <br /> Septic Tank (Specify Requirements) ............ ............. . .......w.............. ............................................. .......I..................... <br /> Disposal Field (Specify Requirements) ...... ............. ............................... .................................. -------------- ...................... <br /> -------------••----------------•----. ....... ........... ..........I................­_­............ ----------_----- <br /> Fr-- ----------------------------------------------- ................ --------- ----------- ........... ..............-•----.....---••-•-----.......................... . ... <br /> (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 Son Joaquin Local Health,District. Nome own" or licen- <br /> sed agents signature certifies the following: <br /> "I certify that in the performanceof the work for which this permit Is Issued, I shall not employ any person In such manner <br /> as to beco ect to Wor"Ots en,20 laws of California." <br /> Signed .................... Owner <br /> H <br /> ;j <br /> -- ---- - 7------------- ................ .. ------------------------------------------ <br /> By -- ----------------------------------------------------- - ---- ------ ---------- Title <br /> (If other than owner] <br /> J FOR DEPARTMENT USE ONLY <br /> -- <br /> APPLICATION ACCEPTED BY ... ....... .. ............ .... <br /> ------­­ DATE....---- ----- <br /> BUILDING PERMIT ISSUED ------------- ........ .......... --- :------•---•----------------DATE .... <br /> ADDITIONALCOMMENTS ------------ ------ ----------------------------------------------......... -------------------------------- .................................. <br /> -- -------------------- -------------- --..-.----- ---......-.-.-.-.-.-.-.-.-.-.-.-.-.-.---- <br /> .--.-.-.-.-.-.-.---- <br /> --.­-.-.-.-...-..-.-.-..-.--.-----------------------------.--.--I-----.--..--.-.----.-.-.-.-..- <br /> ­/.­ <br /> ..-.-.-.-.-.-.-.-.-.--..-.-.-..-...-----.-.-.-.-..-..-..-.-...-.-..-..-..-..-..-.-...-.-...-...-..-...-....-...-.. <br /> . <br /> ... <br /> FinalInspection by. .- ...... ............................................ ........_.......... / .-Date - ----------* ... - <br /> EH 13 24 1-68 Rev. 5 SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3N <br />