Laserfiche WebLink
APPUCATION FOR SAWTATWN PEWIT <br /> Iconwwe its'Tripffec") Permit No. <br /> Fra <br /> ......................... ------ s t Ve <br /> This Permit Expireer c►Qat !t � � Issued .. <br /> -. T �' <br /> p#itation is hereby made to the San Joaquin Local Health District for a permit to Construct and Install the work herein <br /> scribed. This application is mode in compliance with County Ordinance No. 549 and existing Rules and Regulationst <br /> JC'8 AfJ[]RESS/L4CATlON .---p4:0=t-f-..-H/--4�:�5r7' _ C . (-Ter¢T %�a: � ' ky <br /> - --------------- '.7CENSUS TRACT <br /> ... <br /> Address .........—A-1? ...... �'�- � e ....................._..__,_......_ <br /> -- <br /> �.. j - ---------------- ' ?`r _ <br /> ContractOr's Name a s�a� �' � ................. <br /> .......... .........�.:.�`_.__. .•--��--------•�-------------------------=-------.1_icense #���:'_� `�".._ Phone �`_`"��`.. �"�:r <br /> - ..... <br /> inata#lotion well serves Re encu 0 Apartment House 0 Commercial oTrsailer Court 0 l", <br /> Motel Q C __ °' ia G J _. J'oene <br /> Number of living units:..___------ Number of bedrooms ___:____Garbage Grinder -........:.. Lot Size .- "wVC b-____._-.•.. <br /> ------- <br /> Water Supply: Public System and name ------------------------------7•---------- -----•-------•------=------•-- --------------•- -......_......—private � <br /> Character of soil to a depth of 3 feet. Sand 0 Silt Q- GoY Q Feat 0 Sandy Loam ja C:#aY Laden 0 <br /> Hardgcan Q Adobe 0 Fill Material..............If yes,type _______________ <br /> #Plat plan, shaving size of lot, location of system in relation to wells, buildir*s, etc. most be places# on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet) V� <br /> PACKAW'TREATMENT I SEPTIC TANK{ j size------------------ b <br /> _.._.----•-•---......__ Liquid Depth -•-----•..................� <br /> Capacity <br /> _ ----------- 'fY - Material----. NO. Compartments .__ .............:. <br /> Distance to nearest: Well ---------`r��---------------------Foundation �� ._. Prop. Line �.fr'. ::._.._.:. <br /> LEACI•tM LINE ] ;4 <br /> - . Total Length d4.� <br /> I`lo• of Eines __.._.__ __--_--__-- Length of each line.---------�------�-_-__-• <br /> .¢. fox -- ------ -TYAe Filter I�atariQl <br /> v <br /> Depth Filter Material <br /> Distance to nearest: Well A�' ..CIEPIAGi PtT Depth Diameter ----------__ ......__._ .. Property Line Ay.t f....... <br /> Number Rock l=ined Yes p No a <br /> Water Tabte D�Pth ---------------•---- - <br /> ----•-----...•----------.Rixk Size -•--------•.............. ...... <br /> Distance to neor6st: WOR ------ --------- ..:Faurtdsttfoat <br /> --- Prop. Line <br /> EPAIR/AQDITION(Prev. Sanitation Permit# <br /> -------------- _-- <br /> ------- Date -----------• -....-- <br /> Septic Tank (Specify Requirements ..------_ -- . <br /> Disposal Field (Specify Requkernents) ...............--------------------------------------------- <br /> ....................................--------------------- --------••---•---- ----------•-----•--•-----= -- -- <br /> (Draw existing and required addition on reverse side) <br /> J hereby certify that i have prr Yed this appiecation and that the war& wffl be done in accordance. with Son aeaquin <br /> County Ordinances, State Laws, and Rules attd Regulations of the Son Joaquin Laval Health District. Hoare owner or "con. <br /> sed agents signature certifies the fal awing: <br /> "l ceMfy that in the pert fmcnce of the work frit which this permit is'issues#, f shall not ernplvy any parstrn in such.meaner <br /> as to became subject to Workmares Campenagion laws of Ctriifornita:' <br /> Signed .---- " /v T! _ _ -------------­ -------•----- Owner <br /> Ey---------- <br /> ----__ title <br /> Ilf.athsr � ------- --•-- •---.-•---- <br /> FOR QEPARTMENT. USE 0?4Y <br /> APPLICATION ACCEPTIM 8Y-- - <br /> - ----•-•-•------- - ...•......-.----------------------.-- •------- GATE <br /> 'BUILDING PERM T 1SSUEa ...__....-- -----------------------------DATE ---------- -------- <br /> ALCQM11�4ENTS ........................................I................. _.. ------_......_.. ---- <br /> ----- <br /> ------------------ ._.------- --------..•....-... .._..._......_.__.._.._........._.........._.. -- <br /> - .. .......--------- <br /> A_ <br /> Fiaa#Ln <br /> --- <br /> -----••------ .---•......................••._....----.....Gate <br /> EH �-3 24 1-68 Awa .�--"..�:.�......_.._.. <br /> sAra JOAQulN LOCAL HEALTH DISTRICT 8/74 <br />