Laserfiche WebLink
r, FILECOPY <br /> n°y <br /> r p <br /> FO R OFFICEI.. A <br /> i{?R OFFICE <br /> USE; m <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit No...i...E.!. .. ..�_ <br /> ."-' ""-• (Complete in Triplicate) G <br /> ' <br /> m <br /> t Dote lssued._.5 <br /> qtr f, This Permit Expires i Year From Date issued W�_• �--� <br /> Appls-,tion is hereby made to the son-Joaquin Local Health District for a permit to construct and <br /> in the work herein described <br /> :Thls`applacatinn is made in compliance with County Ordinance No.544 and c•istiny Rules and Regulc tionv: <br /> A. EN TRA .._ <br /> ._ _. SPh . <br /> "T <br /> JOB°ADDRESS/LOCA�TiION-...._.... _ }.. ............ .... <br /> ' <,,aNarrlet=...::CI .......• . '' one.. <br /> "7L ��......... . Cry.. -- Zrp <br /> y. ......... .. <br /> �r�Civvner t <br /> arrf <br /> w.Y... <br /> H <br /> /y . r � Phone.......... <br /> Z -License <br /> tractor <br /> ,Contractor s,Name........ iT <br /> )v. <br /> .,. ,�instailatron.will serye: Residence[ Apartment House❑ Commercial ❑ Trader Court ❑ ir <br /> . " W r Motel ❑ Other......................... .. .......... . <br /> l,�. Grinder_ Lot Size_ do <br /> f living ......Number of <br /> '`Number o <br /> Private <br /> Water Supply Public System and`name_.--- - Cla Loam <br /> is+k�,� Fro ❑ ❑ y Peat❑ Sandy Laam❑ Y.. n 9 <br /> r Characte of sod to a depth of 3 feet:/ Sand Silt Cla ❑ r , <br /> Hardpan Adobe❑ Fill Material.. .........If yes,type-- tact reverse _r <br /> Y {Plot plan,showing size �f lot, location of .ystem in relation to weNs,buildings,etc.must be placed on , ';;i r <br /> NEWT iNSTALLATtON= (No septic tank':or <br /> seepage pit permitted if public sewer is available within 200 feet) <br /> *� <br /> Depth <br /> r t .Ct,Y <br /> :....,.... <br /> ..._ .-.----- <br /> -•__.� .. <br /> .....Liquid SEPTIC TANKSize. <br /> PACKAGE TREATMENT ......• ...No. Compartmens <br /> ._.Moteria ........... <br /> Ca ocrty_:.. :...TYPe Foundation top. <br /> Lin <br /> r <br /> .Distoncetaiearesr:Well............................ ........... .....Total Length <br /> Length of each line: <br /> No.'of Lines._...._ __....__._fi:LEACHNG LINE <br /> -----Depth Filter Materia.........: <br /> V, D' Box _.Type Filter Material <br /> A <br /> r <br /> 40 Distance to nearest:Well............................Foundation....._._---......._..._..-_Property Li <br /> x .......................... <br /> R k F Iled Yes❑:Ry,{P1a[� <br /> _.Diameter................. ..Numaer.--•-- <br /> SEEPAGE PIT I 1 Depth }�: - . ize..------......._.. .... <br /> .............Roc <br /> 1Natsr Table Depth........... <br /> k S' <br /> ...Prop Line'_ <br /> Foundation..:.................... I , <br /> t: .T <br /> . <br /> Distance.to nearest:Weil................. <br /> fM. <br /> y' <br /> f5A P.ArIR/ADD <br /> ...t.... .... <br /> ...... <br /> Permit# ...................................... Date..: . <br /> ITION(Prev.Sanitation .............. ....7R . ............... .............................. <br /> ..........eptic Tank(Specify Requirements)...... <br /> f <br /> Disposal Field (Specify Requirementsy-...} - �rX s ................. <br /> #u € ... ._....... •........ .......... <br /> ....}.r.... ? a <br /> + (Draw ei.ist;ng and required addition on reverse side) :Y <br /> 1 ltirtby_tertify that 1 have prepared this application and that the work will be done in accordance with*Son Joaquin:County k <br /> Ordinnnt�s,g S".Laws, and Rules and Regulations of the San Jaagvin Local Health District. Home owner or l:te sled agen, U : <br /> dpndt+rre c"fl""the following:. ' arson in such nanrter+asxc <br /> I car;ify.th^1,iri the parfermante of`the work far which this permit is issued, 1 shall not employ any P 2-n^' <br /> �tobrcom� su5jatt=to Wj 01 m n's Compensation laws of California." <br /> Owner <br /> Signed ,. ... .._.... ! ................ ..... <br /> r ti � <br /> f . <br /> eta B r <br /> ��� , (If other'than'owner) <br /> t K s r. ,:- . . FOR DEPARTMENT 115E O Y - -- <br /> TE <br /> APPLICATION ACCEPTED BY:__.. - <br /> •--' ....................--•..DA <br /> DATE................. <br /> ,DIVISlON OF LAND NUMBER._... ...... + <br /> ADDITIONAL COMMENTS.......... . ...................•---..........._....................... <br /> ............ <br /> -......•--.... ............................_-._...._..... --••-- . . <br /> --------- ................. <br /> f'a .. ............................................................................ <br /> ....................•--.....__...----_......... <br /> 7 <br /> .................... ........... ... ..: <br /> `/.... <br /> Final Inspection 6y:............ ...__ r21672 REV,7/7e..T.vn. <br /> i <br /> • <br /> SAN JOAQUtN LOCAL HEALTH DISTRK'T <br /> 04 13 2a <br />