Laserfiche WebLink
t �l l �'f <br /> FOR OFFICE USE: ' t I�] I <br /> APPLICATION FOR SANITATION PERM( N\ <br /> ............ - - _ - Permit No <br /> ----- (Complete in Triplicate) <br /> - ----------- 3/--� <br /> __.... This Permit Ex Cres 1 Year From Date Issued Date Issued ....... ../. <br /> ie <br /> ,pplication 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/LOCATIO ----. fP_. ,--5-----p �NTER.Q �-Ste,-------------CENSUS TRACT' _._�. .��... <br /> Owner's Name .--------- - RFC1�J LuQ - -- -- - ....Phone <br /> Address --------------- Q3' .. <br /> f ., ------� Q... City ------------------- .......................... <br /> --- - - <br /> Contractor's Name --- Q- N R --------------------_--- ------ -...... ----------License #t -- -------------------- Phone-'-............................. <br /> Installation will serve: Residence ff%�;rtrnent House Commercial ❑Trailer Court ❑ <br /> Motel ❑Other----- ------------------------------- <br /> Number of living units:- -Y__ Number of bedrooms 2:=.Garbage Grinder /Va_ Lot Size .....-- <br /> Water Supply: Public System and name ...___------------------------------ -----------------------------------------------------------------Private 0__ , <br /> Character of soil to a depth of 3'feet: Sand{] Silt Clay E] Peat❑ Sandy Loam C] Clay Loam <br /> Hardpan Adobe ❑ Fill Material ------------ If yes,type ..-..._...---_-.----_-- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etcust be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is avails le within 200 feet,) <br /> PACKAGE TREATMENT ( ] SEPTIC TANK f ] Size...............--_—..--_.---___ --. --- Liquid Depth ...............— OO <br /> Capacity ...-----.......___ Ty -.....,.. Material---------_---------- o. Compartments '_ <br /> - p <br /> Distance to nearest: Wel -------------------------Fo6yidofian -___ __ Prop. Line ...................... 0 <br /> LEACHING LINE [ ] No. of Lines ........___-----__. Length of each line------ ------------- --. Total Length ...-...-._............... <br /> 'D' Box ............ Type Filti r Material ....................Depth Filter M erial .......................................... <br /> Distance to nearest: Well _-____---..--__-_--- Foundation -------- - __ Properly Line ........................ rn <br /> SEEPAGE PIT [ ] Depth .........----------- Dia r --.---.- -_- -Number ----------- .------- --.. Rock Filled Yes ❑ No 01 <br /> Water Table Depth ...... . . ..........._..........._......Rock Size ...... . ...-.--.--....... tt <br /> Distance to nearest:Well -------.--..-.-.----_----_:_...Foundation ----- --------•--- Prop. Line ............ ------ <br /> REPAIR/ADDITION(Prev. SaiWtotion-Pettinii i! =- t''=- -----------------------=. Dafe --------.-...-.-.------------) 'A <br /> Vf <br /> Septic Tank (Specify Requirements) ----------------••---•-------------------------t- P <br /> Disposal Field (Specify Requirements) ------Ahpm:�-------�.-----------O- ----IIE-A14 ------41 N�---­------- <br /> ---------60 K---- <br /> -- ---------------60K---- A-6]H-0 ----------- <br /> ---- <br /> c (N � S _ f <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 Son Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen. <br /> sed agents s' nature certifies the following: <br /> "I certify a in the performs f t work for which this permit is issued, I shall not employ any person in such manner <br /> as to bec a sub' ct to Wor pensation laws of California." <br /> Signed - - _ ......------ -y----- pp----- -- Owner <br /> By ...---------------....-._-----------------------------------------F---c.h. --- 7iTle ------------------....._..----- - -_..._ <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----rAg------------------------...--------_----------------------------- ------PATE - .e ------- <br /> BUILDING PERMIT ISSUED --------------- ---------------.....................I——-------_---------------------------------_DATE <br /> \DDITIONAL COMMENTS ---- - ---- ... - <br /> ----- - ----------------------. . . ...... -- - ...... --- ------------------------------._.........---- ------... ......' --------------------- <br /> . - - -- ------ <br /> ------- ------- - - <br /> - - - - -- --------- .... . -------- ------ <br /> ----------- --- ------ - - ----------- <br /> ----- - ------------------------------ <br /> ----- - -------- -- ------------ <br /> Fnallnsp - - - -r----------------------Date .. -F-f - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M ' <br />