Laserfiche WebLink
FOR OFFICE USE: �/APPLICATION FOR SANITATION PIERM]f:1', FOR OFFICE USE: <br /> (Complete in Triplicate) Permit No.,�,26,-Ml <br /> -------------------------------------------------------- <br /> --------------------- - - ---------------------- This Permit Expires I Year From Date Issued Date Issued../-2__-,7?!2:-�.7Y .: <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is mode in compliance with County Ordinance No. 549 and existing Rules and Regulations:- <br /> JOB ADDRESS/LOCATION-------- -------------------- ........CENSPS-TRACT-----------------------�_x-------- <br /> Owner's Name---- <br /> ---------------------------------------------------------------------------- ------------ ------------------ <br /> Address-------- 5r-6- <br /> 41- -----------I---------------------------- ------------------ ---Zip--- ----- - - ---------- <br /> ----------------------- <br /> Contractor's Name_ -- --------- e:!-11cense i�l----- ----Phone--------__--------------------- <br /> Apartment House-.0 ComrKer8al-[]-Trailer Court <br /> Insiallation will serve. 'kesi�ence <br /> C�, <br /> Motel E] Other------------ <br /> ----------------- <br /> -------------- <br /> Number of living units:----4-----------Number bf,bedwoms------------Gbr_�ag�e�Grincle-r-- ---------Lot-Size--- <br /> X -- -- --- ------------------------------------ <br /> Water Supplr'Public-�ystem and nam oo, I i <br /> , I"Li <br /> ---------------------------------- ------------------------------------------------ -------- -----------Private <br /> Character of soil to a depth of Vdiet: Sand, Silt [I -06y"-E--re�t Ej Sandy Loam 0 Clay Lo6m <br /> ,�?dpan-E] Adob6 rilt kca i'e r i a I------------If yes, type------------------ ------------- 4 <br /> (Plot plan, showing size of lot, location of sy0em"ih-,relation to wells, buildings, etc. must be placed on)reverse <br /> NEW INSTALLATION: (No �septic f6k 6i"s-e-epage pit permitted if public sewer is available within 200-feet,)' <br /> ee <br /> PACKAGE TREATMENT SEPTIC TANK Size--------672?<_ ------Liquid Depth--------------------------- <br /> 2j, <br /> li.. .-. ' aterial---------/-d- ----------No. Compartments--- ---- <br /> Capacity---i1*12d ------Type <br /> ;�----------------------- I <br /> ..Distance to.nearest:.Well----------------------I------------------ n e. <br /> Fouridation.4-0 -------------Prop. Li <br /> LE�CHING LINE 'No. of Lines_._,.�--------- -----------Length O`f each line...... Toltal Length --------------------- <br /> 'D' BOX---r/-------Type Filter Material-.440-14-/��epth Filter Materi.aIL__-_!-A----o/5;;7__*------- -----------I---------------------- <br /> Distance to nearest:Well-I-------------------�'­-Founclation-3-51 ------ Property Line....47-A--------------------- <br /> 4 <br /> SEEPAGE PITI Depth-------------- Diameter-------- -----------Number--------------------------------Y? Rock Fille�d Yes M No E] <br /> Water Table Depth---z------- _Ji-------------I-------------Rock Sizel�------ ------- --------­------------- <br /> Prop. Line-------- ---------------- <br /> Distance to ne-a�est.-Well'-L----- --------------- ----Foundation----------:-- ------------ <br /> ------------ <br /> RE�AIR/ADDITIION (PreJ Sanitation Permit -------------------- ----------------r----Date--------- ---- -------I------------------------ <br /> SepticTank (Specify Req6irements)....... ----------------------------------------------- ---I-----------------e-------------------------------- --------f------------------- <br /> I le, i <br /> Disposal Field (Specify Requirements) i 1_�__ ---------------------------------------- <br /> - ------------------- --------------------------------------------------------------- -1-4- ------------- <br /> --------------------------------------------------------------------------------------------------------------- ------------------------------- --------------- ------------------------------------- - ---------- <br /> -------------------------------------- ----------------------------- - -- - -- -------- --- ---------------------------------------------------------------------------------------------------------------- <br /> jj <br /> (Drav;existing and kquired addition on reverse side) <br /> I hereby-certify that I have prepared this up County.. <br /> , plication and ithat the work will be done in accordance with Son Joaquin <br /> Ordinances, �State Laws,-and-RUlfs-—and- R-11-6tions of the San Joaquin Local Health District. Home owner or licensed agents' <br /> signature certifies the following: <br /> "I certify that in the perform6hiCk-of the workj.orWhich this permit is issued, I shall not employ onj person in -such m4�nner as <br /> to become s'ubject to W'orkman�'s--Cb�-mii-en—sation,laws of California." <br /> Signed----- - - -- - -- ---- ---------------------------------------------Owner <br /> Lt__ <br /> By--------- -- - -- - ----- -- ---- - --------------- ---------------------Title----------- --------------------------------- ------------------------------ <br /> (Ii othe than owner) <br /> F9R R�PMTMENT 11;1�11! ONLY: <br /> �Cc C <br /> APPLICATIO�'L � EPTEDIBY---- - ------ -------------------DATE <br /> DIVISION OF LAND NUMBER.:------------- .......... -------------------------------------------- ------------ -------- -----DATE --------- --- ----------------- ---------- <br /> ADD11-10—MVIC COMMENTS�--- --------------------------------------------------------------­------------------------------------------------------------------ <br /> -----------------------------------I--------------------- -------------- -------------------------------------------------Z------------------------------------------------------------------------------------ <br /> ---------------------------- ------------------------- --------- ----------------------------------------------------- -------------------------------------------------------------------------------------------- <br /> ....... --------- <br /> ----------------------------------------------------- - ---------------- ----- ---------------------------- <br /> Final Inspection by,---7-:---- ------------- Dc3te-.- --- ...... <br /> EH 13 24 <br /> JOAQUIN LOCAL HEALTH DISTRICT F&S 2T677 REV, 7/76 3M� <br />