Laserfiche WebLink
FOR OFFICE USE- <br /> .......................................................... <br /> SE: <br /> f <br /> .•.......�:....:._ APPLICATION FOR SANITATION PERMIT{Complete in.Tripiieata) Permit No. .7s��-? .. <br /> .................... _., _ <br /> ......:.................................... Date Issued .,�.F—Q:_7 <br /> This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to co-nstruct 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 �Y <br /> ...CENSIIs RAGT <br /> ` _ T <br /> Owner's Name ._�f-L�/.`:���'.�i__..��.�.�i� � - ... ..................... <br /> _. <br /> /.................. one <br /> Ph <br /> Address ---...���d.!s---• ---------------------- -----�------ <br /> ti. ............�...............................city ._ <br /> Contractor's Name .--- - -. ' __...L€cerise � . �_ Phone <br /> Installation will serve: Residence A Apartment House Commercial_�Trailer Court <br /> Motel ❑Other. <br /> Number of living units:---/------ Number of bedrooms _.X------- Grinder, Lot ize S <br /> _ <br /> Water Supply: Public System and name .....:..-:-................ ................. .......................................... ---- <br /> Character of soil to a depth of 3 feet: Sand L3 Silt"[ ...tea y ❑ Peat❑ �Sandy Loom 0. Clay Loam,] <br /> Hardpan Q Adobe 0 Fill Moterlol� "�"' <br /> .......---:.If=yea,type............... ............ <br /> (Plot plan, showing size of-tot;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 Ifpublic sewer is available within 200 feet,) <br /> PACKAGE"TREATMENT [ SEPTIC TANKQ Size. . `....................... <br /> Liquid Depth ?` <br /> � <br /> Capacity f �df.....- Type0Material&ld.0i4e-!... <br /> - No. Gompa Compartments nts Z-------.-• <br /> Distance. to nearest: Well •� <br /> .................:.Foundation f _.... <br /> : . ---- ...__ Prop. line �.---- <br /> LEACHING LINE ' No. of Lines ----. --------------- Length <br /> of i€ne._ p. ''...... __-- Total Length lf��`...._.._ . O <br /> f ..... <br /> a e �"�y(7e pilfer Material Depth Filter Material,/P <br /> -- _�% <br /> Distance to nearest: Well _:IZf� Foundation ..� °...._ <br /> Property Line .1-OR <br /> .., r... <br /> { <br /> SEEAAG&P <br /> 1T ( ! Depth .__ ......... Diameter .t. P' Number ... ............ Rock Filled Yes No <br /> Water Table Depth ..._---�� ................".-..Rock Size �.-- --. ------• <br /> Distance to nearest: Well ._. '. 2 <br /> .................Foundation ...-•Q----------- Prop. Line A69 ....... <br /> REPAIR/ADDITION(Prev. Sanitation Permit <br /> # ------ ..................................... Date ............ <br /> Septic Tank (Specify Requirements). ' <br /> p + <br /> ................................... - ....................... <br /> Disposat Field (Specify Requirements) ............... <br /> .-- <br /> ..................................... ---- .............. •---•••• ...........•-- <br /> ---------------•=----•---------- <br /> (Draw existing and re required addition on reverse id <br /> se}r '� _ - - -- � <br /> I hereby certify that i have prepared this application and that the work will be done in accordance with San Joaquln <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: i <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.ta become subject to Workman's Compensation laws of California." t <br /> Signed _...__.._ _ _ Owner ' <br /> BY - - -- --••---- - - • - - ..__...---. Title - � -�`'��Q'�-'��-.�-•. ................... .. <br /> If other than owner} <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY _- — <br /> l; -==----------- •• ------------------------------------------ <br /> BUILDING ..:._..DATE _.....�:,��: <br /> PERMIT ISSUED _____._.-"-----.---- .- <br /> ADI7iTIONAL COMMENTS ------- <br /> -------- ... <br /> DATE _".................... <br /> -----­----- ---------- ----.-.-----•-- <br /> .------ --- <br /> a •-•---- - ......... . ---------------------------_- ............ <br /> _ -----------------•.......................................... <br /> .--•--• .. ..... .... ........... ... ....... ..... <br /> Final )Hsps - . --- - .. _ ..e;,,...._ ..�f_..�--� <br /> EH 13 2! 1-b 13 p, r -------- <br /> Date" ._. .......... �.__. ..._._.. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />