Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT <br /> IComplefe In Triplicate) Permit No. .,7 -.s_70 <br /> ................ ........._ •.....•.. . ...-----•--------- . This Permit Expires 1 Year From Date Issued Date Issued <br /> Application is hereby made to the San .Joaquin Local 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 /> JOB ADDRESS/LOCATION CENSUS TRACT <br /> - .. ................ <br /> Owner's Name <br /> � _. ;y..f.�.ac s, s�•.� ...... ......................Phone .9 .`cl,..�.1. <br /> Address _, .........�-�.��. '... . • )Y1.1' 6( <br /> ......... ........'�City _.... - <br /> .... <br /> Contractor's Name .__ <br /> tDg.:._. ---.License # sce OL.il. Ph <br /> _ ........................... ------... one <br /> Installation will serve: Res! once Q Apartment House fl Commercial JQTraller Court ❑ <br /> r Motel []Other..................... <br /> ...................... <br /> Number of living units:_.._i'---_. Nur�ibe <br /> 6s r of bedrooms --------....Garbage Grinder Lot Size <br /> Water Supply: Public Syste I and Warne ....... ------•__._ ---• r <br /> --...----...-----•......•-•---. <br /> Private <br /> Character of soil to a dept f 3 feet:'F Sand E] Silt❑ Clay 0 Peat❑ Sandy loam ❑ Clayloam [] <br /> hardpan❑ Adobe E3 Fill Materia! ............ If yes, !� <br /> {Plot plan; showing size lot, Loc ti <br /> on of system in relation to wells, buildings, eft. must be plated �an reverse side.) <br /> NEW INSTALLATION: { septic t'nk or seepage, <br /> 'pit permitted if public sewer is available within 200 feet,) f <br /> PACKAGE!TREATMENTf SEPTIC ANK <br /> ^.._� i Size.. -- _�.._.. }. 1iW <br /> C city .. c9..._ Typei AA-1�'rMateriol.f.•1'i h. 'No.`^C d.ortm .... <br /> ��,�,w _l ants .. ------------ <br /> ' D� tdnceR ta" nearest: Well r <br /> ` '--70A.__.Foundation . <br /> 1 .........._ Prop. line .-...zd... <br /> E <br /> LEACHING LINE [ ] <br /> • e.,'..�w. �� No. of L.i_n.eah;'. . - Length <br /> of each lin <br /> e_ .0�.�.. <br /> ............ Total Length th ---------------•- <br /> QBox Typeilterl Mater€al -•-- ---........••- <br /> Filter Material .................................. <br /> Depth <br /> Distance toriearest: Well M <br /> ;t Foundation Property Line <br /> SEEP 'GE P1T ] Depth ..._ ""=-------.i 'Diarnefier ------------- Number ...-•---.----.._...----•.-.. Rock Filled Yes ❑ No <br /> N ? water -Tab4-Depth -------- --------•---•-- flock size ... <br /> Distance to nearest: Well <br /> .....................foundation ............ <br /> ......-- Prop. Line <br /> !EPA[ /ADDITION(Prey. S6hltafion Permit# __------ - <br /> a Date ......... <br /> ----....---- ? <br /> Sepfi€c Tank {Specify_(teguirementsJ �M..--•_-- <br /> -----------•............................................. <br /> Dis�osdl Field (Spe�ify RCquirethtthtsj _ _l f�LA .......fx .....s' PZ`t�. `'j- - . <br /> . . =---- _r9_l`11K_.... -..- . <br /> _._._ ; _ 3 <br /> . <br /> t-------•----------•--------- A-CSN-r�a-w/•NexLiS- ---•-•--q13 ...... ..----S <br /> sting required <br /> ;. <br /> addition on.reverse side) <br /> 1 here4y certify that I have prepared this application and that the work will be done in accordance with San .Joaquin <br /> C6untj Ordinances, State Laws, and. Mules and Regulations of the San Joaquin Lo al Health.flishict. Home owner or Ilton- <br /> sed.a jenti signature certifies,the.-following: <br /> I certify that in the performance of the work far which this .permit is issued, I shall not employ any person in such manner <br /> a: to bac to orkman's CXpen ation laws of California." <br /> 5ignec _.. C_.. ..---..--•- <br /> --• --------• Owner <br /> By - ------------------------- ----- <br /> ------------------- • .----- Title _ <br /> ...................... <br /> . .- I of.er_than._ownerl -- ..;, <br /> FOR DEPARTMENT USE ONLY <br /> i <br /> APPLICATION ACCEPTED BY .R r <br /> BUILDING PERMIT ISSUED ........ �IIfAV�~� ----------------------------------------------- DATE <br /> ------------ <br /> A lTIONAL COMMENTS ................... .. - - -------------------DATE .......... ......_----- <br /> - <br /> .....----••--•------- -------------------------- <br /> - ----- <br /> ----------------_-- <br /> --------------- • ---- <br /> - --------- ---- <br /> ina fns action b - --- - <br /> P y: .. ---------- •-----. <br /> Ef-1 1� 2a 1-hfi Rev. � ........... - - --- - --------------------- ---------------------------------------Date <br /> ... - -`� ----��'`• -�-----....-------- <br /> SAN JOAQUIN LOCA EALTH DISTRICT 8/7h 3M <br />