Laserfiche WebLink
FOR OFFICE USE: <br /> PPLICATIQN fOR-,SANITATION PERI"T <br /> - ------------------------------------------ mi o. ....7.17.. <br /> :. Permit N c <br /> {Complete h Triplicate) <br /> _ ). <br /> .......... -------- �/ - <br /> /� Date Issued ____YY� 72` <br /> ................... ...__-_.___..--..___--.__- This 1Permit Expires 1 Year From Dote Issued � <br /> s Application is hereby made to the San Joaquin Local Health District for,,a_'.permit to construct and install the work hereir. <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> C <br /> JOB ADDRESS/LO ION _ J _ i'r - ---------------------------CENSUS TRACT ..........._.._........... <br /> Owner's Name _ ;.... (' �-/y�lt , ------­--------------------Phone• -----•-----•---- <br /> 117 <br /> Contractor's Name __ � � �'1--- ------ -: ._..._. City -�� � -��-------------------- ----------- <br /> 1 <br /> t ', � ...............•---- ----':,...License # �r; _ Phone _V - ---_��� <br /> Installation will serve: Residence)YApaitmi ent House❑ Commercial ❑Trailer Court <br /> ..A.'. •- <br /> [ � Motel ❑Other ---�•..::...:.....�---=----------=---....-- <br /> Number of living units: _ °,Gar�g Grinder : _�J Lot Size ___ _____________ <br /> - ---. Number of, -. ..: �-. <br /> j <br /> Water Supply. Public System and name .. �ba _ ______________________________________Private ❑ <br /> ,r <br /> Character of soil to a depth of 3 feet: Sand'[] �Silt�p Clay ~ Peat❑ Sandy Loam ❑ Clay Loam ;❑ <br /> � <br /> Hard an. Adobe " FiILMaterial ------------ If yes,type _______ ________________ <br /> 1 <br /> (Piot plan, showing size of lot, location of system in relation forwell's, buildings, etc. must be plci eM` on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permittediffpublic sewer is available within 206 feet,) <br /> h e CA <br /> PACKAGE TREATMENT a f.� <br /> - Ca �a$IEPTIC a� T ; �( ---Size M� �` C_.._- ��.._ : No. Comdaprritnt �_1��-:_ l <br /> P Y YP � ate as P <br /> Qistancet to nearest^ Well j- ►�-`-- � Founda-ion,-. ______________ Prop. Line <br /> LEACHING LI Ef' No. of Lines -:. Length,of a ch line. .: ............ Total Lenges l_ r�_._ -....___.. <br /> 'D' Box ---•------- -------•------•-•-- <br /> _ Type Filter:Matenal fDepth �Filter.'Material � <br /> ! Distan @ta nearest: Well '"r� ._: Foundation ___.___.___ Property Line - <br /> E , '�-' `"� � r <br /> De t� ____.______ Rack Filled Yes ' No <br /> SEEPAGE PIT; [ ] p p ... Qiame#er c� Itumber ------._.. <br /> Water Table Depth ______? _ Rock Size _r___.. <br /> Distance to.nearest: Well --------__________------------..........Foundation ------------ Prop. Line ............. <br /> REPAIR/ADDITION(Prev'. Sanitation Permit# ___________________-__---__------------------ <br /> : Date .................................. <br /> { Septic Tank (Specify Requirements) ---------------------- - -•------------- ----- --•-----•----•-•-•--- .................. <br /> Disposal Field (Specify Requirements) .......... ------------------•--------------------------------------- <br /> ---------------------------------- <br /> '-- . <br /> --------------------------------------------I..•---------------•--•-- <br /> -----------------_---------------------------------_---------------------------------------------------------___-___._--------__-_---_----__-.--_--_-_-----_---__------._---__-_____-____-__-___________- <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 San Joaquin Local Health District. Home owner or licen y <br /> sed agents signature certifies the following-- <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 to become subject to Workman's Compensation laws_of,California." .. _ <br /> !! <br /> Signed •--------- - -•-- ....................... ' <br /> By -------------- - -------------------------------------- - Title <br /> .. ' �k3 <br /> other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED SY .. I ....................•---------------, DATE . r ':- � � �_..._. <br /> ' a:_ . ���._'`----- ----- ---- . ........_ <br /> f BUILDING PERMIT ISSUED -----------------------------------_-----:-•--------------•--------------•-------------------------DATE ............................. ---- - <br /> ADDITIONAL COMMENTS --_-------------- - s =xf <br /> ------------------------------ <br /> --- - <br /> -----------------------------------------------=------------------------------------------------------------------ - <br /> - ---------- <br /> ---- <br /> _ <br /> Final Inspection by: _- - - - Date ------ ----` ----�:---_-----_- ----- - -- - • <br /> SAN <br /> JOAQUIN LOCAL HEALTH DISTRICT <br /> f <br />