Laserfiche WebLink
USE: FOR OFFICE USE: <br /> 0 APPLICATION FOR SANITATION PERMIT <br /> ............. ............. ............ (Complete I.n Triplicate) Permit No.._----------------- <br /> .1.........A.........................I--------- ......... Ax?_-7 <br /> Date Issued...1............. <br /> ...........-;............................................ This Permit Expires I Year From Date Issued <br /> 1. Application is hereby made to-the'San Joaquin Local Health-.District,forb permit to construct and inttall the work herein descri <br /> This application is mbdeln r Qlifl ce ith County Ordiriance N&'549-and'existing Rules and.Re.gulations: <br /> . <br /> JOB ADDRESS/LOCATION.- ........... ------!.3.......... ---------- ....... TRACT. ......... <br /> ' ( <br /> VOL I ------- ---yn .0W.Phone.R.P ...... 0 <br /> Owner's Name....... e.vjVj^.G)SkVV :�l <br /> Addre ss-.--f 2!�..O, f3jo- -Foo, .4--c V P. e L................ <br /> City..L.0c') ..............zip-..:--- <br /> ;_J <br /> Contractor's ------- ...........................-License Phone.......... ....... <br /> Installation will serve. Reti-dince E)_ Apartment House ❑ Commercial rM Trailer Court E] op <br /> ...1 FV <br /> 'Motel JE] Oth�eK......----------------•.•-----.............__. 9.6 <br /> Number of living vnits:................Number of bedrooms'".__..—LGarbageGrinder-..------..-TrL,-otl,Size-2,1(043...X---V09 A'10660( <br /> Water Supply: Public System and name.._.._.._:___--_... . .'..:. _ : -----­---­------------- .............................. .. ..........................Privot, <br /> Character of soil to a depth of 3 feet. Sand 0 %7SiWE'] Clay El Peat Sandy Loom 0 Cloy Loam E] <br /> Hardpan 0 Adobe 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 seepage pit ermitted-if is available within 200 feet,) <br /> P p public sewer <br /> PACKAGE TREATMENT SEPTIC TANK V,) Size._J=_ ..................Liquid Depth_ Xv ---------- <br /> ..Material:.{--...:Na. Compartments.....7-7---- ....... <br /> Distance to nearest: Well _ <br /> r.' _15 ...... Foundation..-140. .1..--'--'---Prop. Line.............. <br /> LEACH ING LINE No. of Lines.............I..............Length of each line--_---__10.Q........_-___Total Length ......tn&.......... <br /> 'D'.Box.....I......Type Filter Material....................Depth' <br /> ... ...............Depth'Filter Material.................. ........................................ <br /> Property line........-_---._.....:........ <br /> ­jbistonce to nearest: Well.............................Foundation------------................ <br /> SEEPAGE PIT <br /> p <br /> Deth- ....-Diameter.. <br /> .........Number------ ........................ Rock Filled 'Yes N <br /> '-, . <br /> . <br /> .... ..... ............ <br /> Water Table' 'Depth..................... .... ......................... ....... <br /> .. <br /> I lt <br /> Distance to nearest, <br /> Well--- " --------------Foundation -10Z..... • Line ta­__ <br /> REPAIR/ADDITION (Prev. Sanitation Permit#.............. ................... ...............Date.......I........ ...................... <br /> Septic Tank [Specify Requirements)-__-t- ­­....................................... ........... ................................. <br /> ----------- <br /> Disposal Field tSpecify Requirementsj.i*.,.:T...r.......... ....... •--------•...... .................. ................................................................... .. <br /> .................... <br /> ....................... --------------------- <br /> ----------------------- ......I—....................... <br /> .............. <br /> ------------ --------------------------- ........................................**..........................................................*................*............ <br /> ,(Draw existing and required addition on reverse side) <br /> I...hereby-------_---Certify...that-I---have----,---prepared this application and accordance with Son Joaquin Cc <br /> Ordinances, State Laws, and Rules o'Td Regulations of the Son Joaquin Local Health District, Horne owner or licensed of <br /> 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 mann4 <br /> to become subject to Workman's Compensation laws of' California." <br /> Signed-- ---------- .......... ------------------------------- ---------11......I..............Ownim <br /> By.......- ....... ------------------------­------------------------ .......Title_._........; -------------- .................. .......... <br /> er.than owner) <br /> 1 . <br /> POR DEPARTMENT.USE ONLY <br /> APPLICATION ACCEPTED BY............. .... .. ............. . -------------DATE ....... ----- -- <br /> DIVISION OF LAND NUMBER . ....... .. <br /> ......DATF_ . ........... <br /> -- -- -- - -------- - ------- <br /> ADDITIONAL COMMENTS--- ...... . .. ........ ...... -------- --- ----- ------ <br /> ---------------------------------—­.41(a <br /> ­ ---- -------- - <br /> . ............J111">------- ------I--------- <br /> ......pl� ....................... ­--------------- .......... <br /> -------------------------------------------------- ......... <br /> --------------------------- ------- ---- <br /> . ............ ... <br /> -- ­ <br /> ­ <br /> FinalInspe;6on by..'.......I------------ . .... . ...............-..-..-................ 0 <br /> 1 <br />