Laserfiche WebLink
-Gf �1 �,rR - sfr� - '---� - • rr _ �1 gp:'. .,,` .. _aa� <br /> ^.,4� '. <br /> FOR OFFICE USE: �'' ' <br /> APPLICATION-FOR SANITATION PERM '' i permit f 9 I <br /> -_-- - -------- --_ _._..____________ __ _________ S <br /> w. <br /> ! (Complete in Triplicate) <br /> __ <br /> - -----_--__i_-_;-- This Permit Expires I' Year From Date Issued <br /> Issued ,-3- Z_=_ 2 <br /> Date <br /> I _ <br /> Applicatiori is hereby made to the San Joaquin Local Health District for a permit ,to construct 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 ._:. _Q ��- ,5�_St� -�_�.a.� /O _---------_._CENSUS TRACT ._- ----- -------- <br /> Owner's Name ---- L.l_U�!C', ----------- ' Phone ----------- <br /> -' <br /> , o. ------------- ---------• City <br /> Addres`s'"- --------- --00--lo,-- '---- -�------- - - - ---------- - �,SGC�---'-------------------- <br /> Contractor''.s Name ----- %S if-------------------------------------------------------------------License # --------- ------ Phone ------------------------- <br /> Installation will-serve: Residence ❑Apartment House❑ Commercial :❑Trailer Court <br /> i Motel ❑Other ------------------------------------- ------ <br /> Number of living units:_ ___f_. Number of bedrooms __,Z_____Garba_ge Grinder ------------ Lot Size _._________:____________________________ <br /> Water Supply: Public System and name _____________ -------------------_----------------_------------------------------------------------------Private �— <br /> I <br /> Character of soil to.a depth-of 3 feet: Sand' Silt❑ Clay ❑ Peat ❑ Sandy Loam '❑ Clay Loam ❑ <br /> •--'.Hardpan ❑ Adobe fes] Fill 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: (No septic tank or see pit permitted if public sewer is available within 200 feet,} <br /> PACKAGE TREATMENT [ ] SEPTIC TANK [ 5ize___ ____i______ Liquid Depth ...... <br /> Capacity .2e.-I.&O____.,__ Typ - <br /> Material CrwC-r91__ No. Compartments _-_-Z__-_______- <br /> Distance to nearest: Well ____./(942-—__________________Foundation ----------- Prop. Line <br /> LEACHING LINE [s, ,,,.,No`.. of;Lines ------� --------------- Length of each line.__---A�°______..__;___ Total Length _____f_ <br /> D' "Box Type Filter Material .Depth Filter Material ________l -------------------------- <br /> ______ <br /> Distance to nearest: Well ----14:2 Fl undation _� ._�__._;'__-.__ Property line <br /> SEEPAGE PIT [ j Depth`. �-- Diamete'r G umber r. — Rock Filled Yes ❑ No C, <br /> Water Table yM1 <br /> Depth )------------------------ ---- ------------ I ----- - ' <br /> Distance to nearest: Well __________________ ..........Foundation _ :_ _________�i Prop.-Line ...................... <br /> ----- <br /> REPAIR/ADDITION(Prev, Sanitation Permit# ------------------------------------g------- Date ---------------------------------`)" _ <br /> Septic Tank (Specify Req.uirements) ____ _________________5_ __________:_ ____ , ------------------I----------------------------,------------------ ---------- <br /> Disposal Field (Specify Reguirements) ------------fqj7,--,__ G -------- <br /> ------------------------------- <br /> -­ <br /> ,__ --_ _________________________ ___ <br /> l <br /> ��. --------.�---- ---------------- ----- --------------------� --I-1- Lx + '-} � <br /> 1.___. _. <br /> - Y ,�--�.. {Draw-exisfiing and'regvired addition on reverse- ide)�i�-�- -- ------------------ <br /> •�<<,�---� --�•�- • <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-Re_gul6tions df'tho San Joaquin-Eoc`ai Health District. Home owner or licen- <br /> sed agents signature certifies the following: y <br /> "I certify that in the performance of the work for..which this permlit,is issued, I shall not employ any person--in--such-manner <br /> Signed �. _ -'.----- '•J,` O vne, <br /> as to bec me �ett to Workman's C ensation laws of California <br /> y <br /> By e�r. ------------------------------- - ----- <br /> --------- <br /> ------------- T -! <br /> itl ` ! - <br /> (If other than owne'r.} V " t €'"" <br /> Ica 4 FORDEPARTMENT'USE ONLY M <br /> APPLICATION ACCEPTED BY ---- ems'-..- -`- . �=" = �:_ �"=="f-DATE_--=.` '-2 <br /> BUILDINGPERMIT ISSUED --------------------------------------------------------------------------- ---------------------- DATE -------------------------------------------------------------- <br /> ADDITIONAL COMMENTS __ <br /> --------------------------------- - ------ - -- - ------------------ ---- ------------------ ------------------------- <br /> --------- <br /> ---------------- <br /> --------- --- ------- -------------- ------ ---------- ---- - ---- ----------------------------- -- --- --------- -------------------- ---- <br /> - - <br /> i <br /> ;� <br /> Final Inspe n by: --- Date - - -"�--- ------------- ------ ---- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> v ' <br /> E. H. 9 1-'b8 Rev. 5M !z <br />