Laserfiche WebLink
FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit No. -.?!.•`-6..... <br /> ----------- -­ .....-......•---`---. ....... (Complete in Triplicate) i <br /> ued .:7111..71-7 <br /> Date Iss <br /> This Permit Expires I year From Date issued <br /> .... ----------------------- <br /> le In Joaquin Local Health District for a permit to construct and install the work herein <br /> Application is hereby mode to the Rules described. This application is mcdi;in-compliance with County Ordinance NO. 549 and existing R le and Regulations: <br /> CT ..............-1...... <br /> ---CENSUS TRA <br /> JOB jADDR.ESS/LOCATION ........ <br /> .-Pho -Morf—_.- <br /> -Name. <br /> Owner's ar <br /> Ci ......... -------- <br /> Address ...... Phone <br /> O <br /> --------License # 5?....... <br /> Contractor's Nam. <br /> Installation will serve: Residence C]Apartment HouseO Commercial frailer Court <br /> Motel E]other_----_---_----------------- ----------- <br /> 7 <br /> rooms .........P.Garbage Grinder ..... Lot Size, ...... <br /> Number of living units:............ Number of bed <br /> ate ❑ <br /> water Supply: Public System and name <br /> Chd'rocter of soil to a depth of 3 feet: Sand 0 AVSilt.0 Clay E] Peat 0 Sandy Loam to'tj L <br /> Hardpan E] AdolooX Fill Material ..... ------ if yes,type ------------------- <br /> location of system in relation to wells, buildings etc. must be placed <br /> an reverse sid <br /> 7P141plan, showing size of lot . —1 1") . � V <br /> pit permitted if public sewer ig available within 200 feet,, <br /> NEV;INSTALLATION: (No septic(tank or seepage Liquid Depth <br /> PAdKAGE TREATMENT [ I rs CaSEPTICTANK11 Size...AOX/0--- ----- ---------- <br /> Compartments ............ <br /> pacity Oeo.P <br /> __ __0------ Type P44000-- Material No. <br /> Distance to nearest: Well ............... <br /> I --------Foundation_.................... Prop. Line. <br /> , <br /> LINE No. of Line4__------.l___..__.._kengtof each line.... IVC4P-- --- T0t [ Length ............ <br /> LEACHING <br /> . .. .. ............ <br /> D' Box J --- Type Filter Material <br /> Aq.-fW ....Depth Filter Material . . . . .. <br /> • Distance To nearest- Well ..... .................. Foundation ---------z, ---- Property Line <br /> Diameter �3%3.w­ Number -------/-;Z1 Rock Filled YejX No 0 <br /> SEIEPXGE PIT Depth . ...... ---- of <br /> I _1... ..Rock Siz,e` .... .... <br /> Water Toble,,-`Depth ,.............J------------------------ <br /> I., k oun-;­lon .................... Prop. Llnoi;--------------------- <br /> Distance to nearest: Well ......J�............. <br /> .1 Date ......':<'........................ <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------- -------- <br /> 1 1 _ A ­­..............­,......I..................... <br /> ...................................... <br /> Septic Tank (Specify Requiremdnts) ....!------------- .................. ....; - <br /> I ': '. ..... ............. ....... <br /> ............ ........ .............. <br /> Disposal Field (Specify Requirements) ................... <br /> e, ............... .................... <br /> ..................... .............................:------ ---------------- <br /> A........................ ........ <br /> ............ It r .........I.. ............................. ------- ................................ ..................... <br /> ------- - --- ---- ---- J..................... -----------j*r*' reverse side) <br /> ...... (Draw existing and e4ulred addition on rev n accordance wit Son Joaquin <br /> I hereby certify that I have Prepared this application' and that the work will be done 1 4-N licen- <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Hems'41Wnor Or_ <br /> sed agents signature certifies the following: <br /> it is issued, I shall not employ aniT n in such manner <br /> person <br /> "I certify that in the Performance'of the work for which this Perm <br /> ;y <br /> as to become subject'io..Wor.kman's,Componsation.ia.ws of California." i. <br /> Signe I ------ -e --Owner <br /> Title ..- <br /> ............ .......... I......,.... <br /> ByA --_------- ------------_- ------ -----_-------- <br /> 4�rvii other than owneil <br /> I GT FOR P TMENY USE ONLY <br /> DATE ... ....... ......... <br /> .......... ................. ..............--- .��.1,7' 1 / <br /> APPLICATION ACCEPTED BY ....I ............. <br /> BUILDING PERMIT ISSUED ....- - - -- ---- - - ---------- -------------------------------------------- ----------- DATE -------------------••-----'---------------------- <br /> j.....I—................­---------------------- ............­..............-4 ........ <br /> AD TIONAL COMMENTS' ...................A_.... <br /> 0 r. .. ........ -------------­................. .................. ......... <br /> ---------------I I ........ <br /> ----------- ----------- ............. ......................................­.................. . <br /> _IP ---- - ----- ------------- <br /> ­ ----------------- <br /> ..................................... .................. <br /> --------­-----6 -2-6 ... .. .......... <br /> . ate <br /> n...j�j...s' ............ ......... ............. .............. <br /> I a 1 n pection by� ........I.,........ <br /> N)OAQUIN7LOCAL HEALTH DISTRICT <br />