Laserfiche WebLink
f FOR OFFICE USE: <br /> APPLICATION FOJt SANITATION PERMIT <br /> ..••.............•---....... ---••• .- ��""° Pet`rnit No. ._7C <br /> ;C ..,.. plicatel <br /> in Tri <br /> ..................•-•------•-........:.........:......... _ <br /> '._ Date Issued - <br /> This hermit Expires 1 Year From Date Issued <br /> r ' <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 comp€• rice with County Ordinance No. 549 and existing Rules and Regulations: <br /> ' . <br /> JOB ADDRESS/LOCATIO ." �_ .. _. .....CENSUS TRACT <br /> Owner's Name .... / ............................,....................:------.. .. ..Phone . ". _�°O <br /> f . <br /> Address -------- ____ ' <br /> ----• ---- - city <br /> PhoneContractor's Name ------------- - --------•- -- -.._....:--•------------- ..........------.License # ................... ------------ ........... <br /> .Installation will serve: Re sidenceX Apartment House] Commercial QTraller Court Q <br /> Motel ❑Other............................................ L <br /> Number of living units:4 Number of bedrooms--------Garbage Grinder ...._.:.... Lot Size <br /> Water Supply: Public System and name ........ .................................Private ❑ <br /> Character of soil.to a depth of 3 feet: Sand E] Silt Q Clay 0 Peat❑ Sandy Loam Q Clay Loam-6 <br /> .Hardpan p Adobe Q� Fill Material ............ If yes,type............... ............ <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 perm <br /> jtted If public sewer is available within 200 feet) <br /> _ r <br /> PACKAGE TREATMENT [ 7' SEPTIC TANK f,-<f5r q112i .................... ..•-:______-•__•.._..... Liquid. Depth ......................... <br /> ___ Material...... <br /> Capacity - Type � •--.. No. Compartments <br /> .............. <br /> Distance to nearest: Well ....................•___.____••_-----Found ation ...................... Prop. Line .............. <br /> LEACHING i.INE No. of tines r��.. ""- Length of each lin �:. ......_ Total Length ... d.. .......... <br /> �� 'D' Box . Type Filter Materia ..:Depfh`.F€Iter Material ....._1 '�........s......... <br />' Distance to nearest: Well ✓��___. .... Foundation ... ................ property tine` - _ <br /> r a r <br /> ter�.. NDepth ------ umbar .......... <br /> Rock Filled Yes, No Q <br /> K <br /> >�lde A64S M ✓ Water Table Depth --- .................................•--.....Rock Size .-7 . ------------•--- <br /> Distance toInearest: Well -----------------•-----•--..............Foundation ------......._. .... Prop. Line ...................... <br /> € 9PA1R/ADDITION(Prev. Sanitation lPermit# ......................................:.....'Date ---.-___...-_._...._.............I <br /> SepticTank (Specify Requirements) ---------------•-- -----------••...................r..................... ...................................._... --•---•-.................. <br /> DisposalField (Specify Requirements) ................. ------ ................... ....................................................... ........................... <br /> ------------------------•----------------..-------------------•-............................................ •--•---- ----"-• .................... <br /> h� .............""-"--•-"•-"--""""--" -----------------•- ----------------•----------- =------------- ..:..._..... ........ ••-• ---••-----•--• <br /> i <br /> Draw existing and required addition on reverse side( lY -- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with,-San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health,District. Horne owner or <br /> self agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is issued, 1 small not ern'll y'any person in such manner <br /> as to become su lett to Workman's Compensation laws of California." <br /> Signed __...__..-_. -c ._. ws ......._.., :_ Owner <br /> By <br /> `` -------� (if other than owner) <br /> ! EPARTMENT_USE ONLY <br /> APPLICATION ACCEPTED BY <br /> ------ <br /> ----••- ---. .... _.-- . <br /> ......--.A_.T <br /> fBUILDING PERMIT ISSUED __--.- .. - = :._.. .DAT_. <br /> ................._..._..-... <br /> ADDITIONAL COMMENTS ---------=- --!.__...---....---------- ---•------ <br /> ----------------------- ---1 ------------L % % <br /> . <br /> .....---------.:.-.-4-.--•--- <br /> - <br /> ......................_...._.. ..................•------••-..__....._.....__. <br /> . --- -- ---------------------------------- <br /> •----------------................ ------------ -------- <br /> FinalInspection by: _.. ..-- "" --" .. .....:�------------------- --------------------------------.-...-•------------------Date _..._._. . � � --------- --.. <br /> EH 13 2L 1--68 fie '-- <br /> 5 SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br /> t i <br />