Laserfiche WebLink
-FOR t3Ff[CE USE:: - : <br /> ' ` ' ' i" '� APPLICATION FOR SANITATION PERMIT <br /> Pw'mlt Nod.:7l <br /> .......................... lCompletelnTrlptieotal r �O•�yS.. <br /> •...................................._,....... This Permit Expires t Year From Date Issued Date Issued ............... <br /> "Application is hereby made to the San Joaquin1ocal 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 /> a *� <br /> r <br /> �.. <br /> 'JOB ADDRESS/LOCATtL��j'� -• Lla�'•�i3;;4.�Pd .;;. .... ................................CENSUS TRACT .....................I... <br /> l i".:•Owner's Name ../ .FTI•....„ AGO..: ... ':. <br /> r. Address 5 v , ...: � t i r .....�4:..... ....._..................... Phone 7.�. .. ._. <br /> _.......... dry ......I....._....... . <br /> +�' ........_.. <br /> Contractor's ^-' ` l <br /> ... ................ License# <br /> C`installation will serve: "----=-RdsidenceRApartment House o Commercial QTralter Court 0 <br /> N Motel Q Other..............._........ <br /> ................... <br /> Number of living uniti:..:_l-...... Number of bedrooms ...�s.._Garbage Grinder :/l/Ci.. Lot Size ...�O_/ L6t................ <br /> t 1 Water Supply: Public System and name ..... <br /> --------------------— .Private <br /> ---....................................... i <br /> L Character of soil to a depth of 3 feet: -Sand Silt 0 Gay ❑ Peat I] Sandy Loam 0 day Loom Q <br /> (Plot plan, showing size of lot, <br /> Ej Adobe L'] Fill Mcteriof ............ if yes,type...... <br /> , location of system in relation to wells, buildings, etc, must be placed on reverse side.) <br /> NEW INSTAlLAT10N: {No septic tank or seepage pit permitted if public sewer is available within 200 feet) <br /> PACKAGE TREATMENT [j SEPTIC TAMC{ ] l6 <br /> 0 i <br /> . . ........... <br /> ....... Liquid 'Depth ......................:_:r67 <br /> CapacitylLle,J-_--1-... Ty 'Gil .-------- Materb znt.r.,..• No. Compartmenh <br /> Distance to nearest: Well . 47L_. . ..::..Foundation..Zjq. `.._.....Prop. Line... ..� <br /> LEACHING LINE [ ) No. of Lines ; <br /> :_ length of line......................... Total Length g :........:...........#... <br /> 'D' Box ............ Type filter Material .............. Depth filter Material t <br /> Distance to nearest: Well _.........._........... foundation ..:..................... Pt.....-. <br /> • SEEPAGE PIT . - Diameter Number...................::.. ... Rock F Iled Yes .fUp <br /> [ 1 Depth ---.---.-._- _ <br /> Water Table Depth ......:.................----._..:.....'..._::.Rock Size .........:.....:............:... <br /> i` <br /> .. Distance to nearest: Well ....t...:...... _... <br /> Foundation .._................ Prop. LIM .__....._.......;1 <br /> REPAIR/ DITION i�rev. Sanitation Permit# ............ <br /> ...................:...... Date ...........:...........' <br /> Septic Tank{Specfiy Requirements) ...:........./_�.:._ <br /> Disposal Field (SpeSi€y Requirementsi - P.. ....�PaFC..-...LD.' - �- F• ' ) . - ......... ��.� <br /> .... . .. <br /> ................ ..... /.yE <br /> .. <br /> _.�. ...�. ....�.�Gr:talc...... <br /> raw existin dnd req '`"""""" ` <br /> gyi/ed addition on reverse side) r <br /> I hereby certify that J have prepared this applitatfon and ihot Me.work will .be done in accordance with San, leagyta' <br /> County Ordinances, irate Laws, and Rules and, and <br /> of the San Joaquin local Health District.Home owner w Rtxo- <br /> zed agents signature certifies the following: <br /> W certify that in the performance of the work for which this permit is issued; I shall nor employ any persen.ln suth manner <br /> .as to become subject to Workman's•Compensaaon laws of California.,, <br /> i Signed <br /> B ].....................` ...... <br /> Owner l <br /> �^ <br /> - Li lvt'aaTn............ .......... ...__.. 7rtle <br /> other than owner) I <br /> t RDE ARTMENT'USE ONLY , <br /> "(-APPLICATION ACCEPTED BY. 7` ;,. TE 1 <br /> BWILDING fER/�1T ISSI�ED'.... . ..:.. ........... . r. _ ­... _ .. ¢Pii w�yc ✓ : :7_ <br /> ADDiTIONraC CL3MMENTS 6 ..., __.._... . ... TE ......_.. . <br /> .............. <br /> - - !... . <br /> ---o............................. .........................................._._.. <br /> - ... <br /> na!Inspection by: ........... r ............ ..............................................................................Date. � ............. <br /> .... . ..... <br /> 13 211 2-68 lfev+ L...................... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />