Laserfiche WebLink
­` i i oR-Ot f,"USE: APPLICATION FOR SA-WATION PERMIT <br /> Permit No. .-r•••• • •-••- <br /> ........ <br /> ................. <br /> ........ <br /> .... lcompletein Triplleatel . �. - •----- �--- /=�� <br /> —.� ... �. - - Date few" .. <br /> �.�_.._...... . ........- -... + Tb1Penrrtt >t Yec+r#rrent DaMissued <br /> i ....... f q <br /> lication.is hereby trade to the San Joaquin total Health district for a permit to aonstriitt t+� Install the warts heroin , ; <br /> Application. <br /> Pp. application is +made in compliance with County Ordinance No. sr44 and existing Rules and Regu1ationh ` { <br /> described. This app i <br /> 'JOB ADDRESSn �:. ...... .�c -fir.. . .....................................................:.:....... P / _.... <br /> Owner's Name r C�. City� . ,,..........................- <br /> Address . . ........... 1,rc SSD /........./.. ....................License $ ........................ Phone ......... ............... <br /> Contractor's Name <br /> installation will.server itesid oe Q ApartmOnt Hous .0 C;omtmerdatMotel E3 Other �raller�� El <br /> i <br /> `' of bedroar�is.............. <br /> ..Garbage.Gri�tdor ............ Lot Sire ..,a .•�"�G=' ........ <br /> Number of living units*.... -Number ......... .:...Private <br /> Water Supply: Public system and name ........ ........................._....._.__......_..._...................:................ .loamy �� <br /> Clay Peat❑ Sandy Loam ay <br /> Character of soif to a depth of 3"Fee}: . Sand t3 Silt{� [� } <br /> •�i•fardpon❑ . Adore fl' Fill Materia! . If yes,type { <br /> �. (Plot plan, showing size of tot. location of system in relation•to wells, buildings, etc, must be placed an reverse Side• i <br /> ` itted if public sewer is available within 200 feetl <br /> NEW INSTALLATION. (No $eptic tank ar.seepage-pit-perm p � + .........�. <br /> SEP7lC TAHK# Size .... .... Liquid De <br /> PACKAGE <br /> TREATMENT [ ] E L No. Compartments ... .... -- <br /> Capacity .......... ----••- Type !ilaferia <br /> nearest: .Foundation .............. Prop.Line <br /> Distance.to <br /> Well -� ; f del <br /> I f. length :AINa. <br /> i ,/ -•.... .. Total length �� <br /> LEACHING LINE No. of Lines .-----_ ..-•:--••- <br /> i ` Filter Mater al !Depth Filter M*tertal .--...+ .....r. <br /> 'D' Box .._....--_.. Type . o .. ..._.. �..._... ..� 0.::f'. <br /> . - Distance to nearest, 11Veil •.1 . <br /> f=oundation ;MP/0.. Property Line D <br /> De th ... r ........... Diameter .. Number.......-•---........-•_..... R let! Yes ❑ 1V <br /> _ ask Filled o 01 <br /> SirEPAGE PIT [ t p. ................. ........................-. <br /> •�• ask Sire f <br /> Water Table Depth ..,,..�.. <br /> t <br /> 'Distance to nearest:Well- : '= ...Foundation ....--- ........ Prop. l Atte ... �--..--. <br /> iEEirAlti/ADDITION(Prev.Sanitatia Permit* ................................. _ Data .. ............................ . <br /> Septic Tank(Specify Requirements) ............ = -_ !''.'. " - ......... <br /> Disposal 'Field (Specify Requirements) <br /> � ------- <br /> 44, <br /> .-- <br /> .. ` s••.•. "- <br /> .................................................. <br /> •.. .��.... ..---•- •.... ....... .......... <br /> . ........ <br /> ............ .......................................... <br /> ............... <br /> � <br /> rse side <br /> t (Draw existing and required addition on rave 1 <br /> I hereby certify that l have prepared this application and that ttte work will be done in aceadanta with Sas taagtdn <br /> County Ordinances, State taws. and- Rvlas and Regulbtions sf the San Joaquin Local HeaithalisMst.Name owner or ilcew <br /> sed agents signature certifies the followings erect is issued. I $hail not employ ally person is sear manner <br /> 4 comfy rha#-i a parfo anee of the work fair-whicb this p <br /> t, as to boc ta rkman.s Campdon aws of Califarnia." <br /> P .......-Owner <br /> 8 ......_...... Jitie . ;...... •.........-.. <br /> y (if other!ban owner) ' <br /> OR VEPARIMENT USe ONLY ' <br /> DATE1..1. .7�0..: u� <br /> - - <br /> APPLICATION ACCEPTED SY....:. - -- - -- .• <br /> _.� . . ........:......DATE.. .._:........---................._._ <br /> BUILDING PERMIT'ISSUED:."'`_."`......... ............. ...................�- � ::. <br /> ........... <br /> ADDITIONAL COMMENTS ..................................--_.-_ <br /> ........ ....... - . ..�. _ ...---........- ..... ...•• <br /> ._... ---•--....... .....-----... ................... <br /> j .... ........... <br /> -0- <br /> - <br /> ..-..�.__.......................--• -...........-•-..............Date1.:.�'.: ..: ............ <br /> Fina!Inspection hY� .._....�?"�- - . tf..�• <br /> �, EH 1.3 24 1-60 Rev. 5l � SAN JOAQUIN LOCAL HEALTH DISTRACT 8/7h 3H <br />