Laserfiche WebLink
i %-OR OFFICE USE: <br /> �.s r'PP1,11CATiON FOR SAINiTATION PER <br /> ............... <br /> ..................... ....... __ <br /> "err;7it `:tic. ...=-j -- - 1 <br /> (Corriplute in TripliecEtel <br /> e - - <br /> ­/ <br /> -------------------------------------.- This Permit Expires 7 'Pear From Date Issues€ <br /> Date Issoed .. <br /> 4 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the F.vork herein <br /> 4 described, This application is made in compliance with County Ordinance No. 549 and existing Ruses and Reguic loos: <br /> L .G <br /> JO6 A,DDRE55/LOCATIO ,:._,_,f�.r'�.._� - .-----�---- �le._�-.:_e:: --a::�':............ . .—CENSUS TRACT --- --------- <br />` Owner's Name -~ c� ------------------------ -- ------- --.-'.. Phone <br /> r -- c` z City ----- - ------------- ---------------------------------------- <br /> - Address / `2 E ---- <br /> �� j <br /> Contractor's Name . `��€'`�- -tir_1c _ �. ._ F - :z_ License # j-?l 1.3 i!7r.. Phone <br />{ � --[- ; --, <br /> l Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court '.❑ <br /> k <br /> Motel ❑ Other ----- = - � - <br /> Number of [sting units:..-T Number of bedrooms _ --��-------Garbage Grinder ...-........ Lot Size -_-C�----'� - � � _--.----- <br /> ----- --------- <br /> 4_ Water Supply: Public System and name ------- ---------- ------------------------------Private <br /> Character <br /> of soil to a depth of 3 feet: Sand.❑ Silt ❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan Fil Adobe D Fill Material -.---------- If yes, type ---------------------------- <br /> I k <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 permitted ifRublic sewer is available within 200 feet,) <br /> y S <br /> PACKAGE TREATMENT [ ] SEPT�C�TANK'[��A„� Size-�s'} r�- -- ----------------------- Liquid Depth --S'--------------------- b <br /> e.� Capacity/`-r --------k. e -------------------- Material---.-------.------.--- No.. Compartments ---------------------- � <br /> t i Distance to nearest: WL-11 ------------------------------------Foundation --------------------- Prop. Line ------------------__ <br /> LEACHING LINE [ ] No. of Lines ________________________ Length of each line---------------------------- Total Length _-------------.------------ 1IZ3 <br /> 'D' Box ------------ Type Filter Material --------------------Depth Filter Material ----- ----------------------- <br /> Distance to nearest: Well _______________________ Foundation --------- -------------- Property Line ----------- <br /> SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ---------------------- Rock Filled Yes E] No i❑ <br /> Water Table Depth ----------------------------------- Rock Size ----------------- <br /> Distance to nearest: Well ------------------------------------- Foundation -------------------- Prop. Line ---------------------- <br /> REPAIR/ADDITION{Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------} <br /> Septic Tank (Specify Requirements) _________________________________________ _ <br /> Disposal Field (Specify Requirements] i �-1 E -t_-- -- - a � �---y ,' <br /> cry c-L' , - - _ <br /> - <br /> -- H �, <br /> l✓ <br /> (Draw existing and required adZt�ion on reverse side) <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with Safi Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed ---------------- --- -- ---- ------- --------- - Owner _ <br /> t t3 ti.- ,1- --- <br /> Y ------------------- -- - - - nzTitle Vii. ��,` <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> - APPLICATION ACCEPTED BY -.w%-.==_--- :---- DATE .............-------__ <br /> BUILDING PERAAIT ISSUED ............... .. --.----------DATE .-.-._.-.---...------- <br /> ----------------------------- ---- - - --...-------- -- - -------------------- <br /> ADDITIONALCOMMENTS ------------------- --- ----------- --- ---- ------ --------- .---- --- ------ .------. ---------..............._.-------------------- --------------- <br /> F! --------------- ............................... <br /> ---- - - ---------- ----- ------------------ ---------------------..... ----- . ------. <br /> - <br /> --­----------------------- <br /> Y--------- <br /> --.. ...... .......................- -. ---- ----.. -- --- <br /> Final Inspection by: -- --... -- ---- .. ------... - -- -Date <br /> F41 SAN 110AQUkN L OCA.L HEALTH DISTRICT <br /> c. : -'6S RQv. SN': <br />