Laserfiche WebLink
FOR OFFICE USE: <br /> APPLICATION FOR SANITAYICN PERMIT f' _ <br /> SSS.............. ...-----..._.:......:................... Permit No.i 4 J --- <br /> (Complete in Triplicate) ................. <br /> uN:... . ...... <br /> This Permit Expir �1 Year From Date;lssaed Date Issued - <br /> Application is hereby made to the San Joaquin Local Health�bistrict fora' permit to construct and install the work herein <br /> described. This application"is made in compliance with County Ordinance No. 544 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION'�O� _--1.--___!�./-U <br /> -:�./.CENSUS TRAGI' ..�r�o............... <br /> Owner's Name .-- _•--_�,C., . ._..__...__Phone <br /> .... <br /> Address ........ c, <br /> .......................................City ' ------ .......................------------------- <br /> Contractor's <br /> ------ ---- -- <br /> Contractor's Name C' lZiel: _ .......:........License # ......................... Phone <br /> Installation will serve: Residence pt_Apartrnent House 0 Commercial oTraller Court 0 <br /> NJ I Motel ❑Other <br /> Number of living units: �M' Number of bedrooms -�---•--Garbage Grinder _..✓.....__ LutSaxe ..1��..(G_ wc <br /> ...... <br /> Water Supply Public System and name __ <br /> Character of.soi!to_.a.depth-of-3 feet:,. .Sand- Silt E3 Clay [)--Peat 0 Sandy Loam ❑ Clay Loam ❑ <br /> � . <br /> Hardpers{],.Adobe p ,FIII 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: 4�No�septic tank or <br /> ( p seepage pit permitted if public sewer is available within 200 feet,} <br /> PACKAGE TREATMENT[4 SEPTIC TANK f ) .. Sixe__ CV................•__••___..... Liquid Depth <br /> �+-- Capacity .. �" -................... .-- <br /> TYPr= Material_______________•-•__... No. Compartments .. ......... <br /> u •� r ` <br /> Distance.to .nearest: Well .-----..�:�................Foundation ----AO-._ 4.--. Prop. Line --. <br /> LEACHING LINE [ ] No� of Lines ---� ........ Length of each, ..........._..--_..._. Total Length _ ............ <br /> 'D' ox . .._ /Type .Filter Mpteria(t��9.)4r!8epth .Filter Material� .... � � ------------, <br /> c t- Distance to nearest• WWell ....��_1 Foundation ..... Property Eine '_.:,.a�.�'--...1 <br /> 'SEEPAGE ILiT DeP�t ' <br /> --... Diaeter _9Number ....... ................ Rock Filled Yes,X No <br /> i <br /> Water-Tabfe g Depth,..•--��................................Rock Size ---` ....•-•...... <br /> r <br /> Distance to ne`.arest: Well ._.�. -- ..................Foundation __1 . -f.... Prop. Line ___, `7- . -_---- <br /> REPAIR/AbDITION(Prey. SanitationPermit# ................ ........................... Date ____--.. ................... <br /> Septic Tank (Specify Requirements).ems'. e i4 ..... <br /> :.I ....................._.....--•••--•-•-----........ <br /> Disposal Field (Specify Requirements} ............................•-._----__._...._-.-._____. <br /> ----------------------------- --------••----- ` <br /> ill . . . . . ..... - --------------------- <br /> ---------------- <br /> - ........................ <br /> I ----------•-•---- -,,; ---•-•• <br /> ---------- - -------- - --....- •---.. <br /> (Draw existingandrequiredadditi_o.n.o.n.reverseside) <br /> 1 hereby certify that I have prepared this application and that the work will be done In accordance with Son Joaquin <br /> County Ordinanc State Laws, and Rules and Regulations of the San Joaquin Local Health,Dishid. Horne owner or licen- <br /> sed agents si at ce fies�the following": <br /> "I certify that t p oe nc of the wor for which this p iMit.is issued, !"'shall not employ any person in such manner <br /> as to become b( c t o tion laws of California." <br /> Signed • =r= ................ Oner <br /> k <br /> -- - Tit#e ----- -•- _.� _. <br /> ` = <br /> f other than owned ice: ' <br /> f <br />' I! FO EPARTMENT USE ONLY <br /> '" . / `_`- `,ti: "- DATE . <br /> ...-•-••..-•--= <br /> BUILDING PERMIT ISSUED ------- <br /> -- ----- DATE <br /> ADDITIONAL COMMENTS fir`• l' c�.-sem � e • cls -.-................... :.......................... <br /> .................----------------------i------------- ----- <br /> •--•---•----• ----------------------•---------••----••-- ........................................ -.-...--- <br /> I <br /> i <br /> 14 <br /> Final Inspection by: -------------- ..�. -. 6- - -------- ...............................Date - --� - ---•--------•-...- <br /> • EH 13 2a J.-bf) Rev. � . . . <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT $/7)j 3M <br /> I <br />