Laserfiche WebLink
FOR OFFICE USE: _.._APPLICATION FOR SANITATION PERMIT <br /> ------------------- ' ted- Permit No. ...71_-_yea <br /> (Complete in Triplicate) <br /> ..........I......................... .................... Date Issued /-_�-r.72c... <br /> ....................................... .........:..... This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the Son 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 /> i <br /> JOB ADDRESS/LOCATION:�O.1`-QO.._ , ---,O.�r.:..... NC it .'-,-----CENSUS TRACT ...................__... <br /> Owner's Name I&LSU-............................................ /^------------......Phone............................--------- <br /> ' Address ...... �}OX ��/........ - � City . ,/� .- -- .................... <br /> Contractor's Name ---C_:e4cz/_��Jr_t ogle-- Lam'!` .':_._...License # +r�.r' /�3-- Phone <br /> 1 Installation will serve: Residence ❑Apartment House❑ Commercial: railer Court 0 <br /> E]Motel Other -- . �_ u�bys <br /> Number of living units:. t1-..Q... Number of bedrooms .Garbage Grinder A142--... Lot Size 1"lea..:........... <br /> Water Supply: Public System and name -------- - -----------------_---------- ------------------ ..........................................Privateer <br /> Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat.❑ Sandy Loam C] Clay Loam <br /> ' Hardpan ❑ Adobe ❑ 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 permitted if public sewer is available within 200 feet,) <br /> !s T <br /> PACKAGE TREATMENT [ I SEPTIC TANK i j Size------ �-_........................ Liquid Depth ._. .............. <br /> . <br /> Capacity Zasa..... -- Type �..f_^ Material__,' '"4acT No. Compartments __?. .' i n <br /> Distance To nearest: Well .....�IQQ.�_________________Foundation ._CGl..........-.. Prop. Line __� .....,...... Q <br /> .. t <br /> LEACHING LINE [ ] No. of Lines -_.,.T............... Length of each line------/d2Q...------- Total Length ............. + <br /> t 'D' Box 6W Type Filter Material 1. c5X. .kp...Depth Filter Material ----AdC._------- <br /> Distance to nearest: Well _/btp............ Foundation ../..Q.......-...___ Property Line ..5..............:.... <br /> SEEPAGE PIT [ ] Depth .................... Diameter ------I--------- Number ............................ Rock Filled Yes ❑ No . <br /> Water Table Depth ............................ -------- --------Rock Size ................................ <br /> Distance to nearest: Well ........................................Foundation --------............. Prop. Line ...................... <br /> t REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ..................................I <br /> Septic Tank (Specify Requirements) - ----------....................... ------------------------_- .............................................. -- .-.................. <br /> Disposal Field (Specify :Requirements) ........----•....................................... ............................. .......... --------- <br /> .......................... ......... ....... ................................................. ..._--------------- ............................. <br /> ----------------------------------------------- - -- ... -----..... ----------------------.....---....._....... ------------ - 1­.......... -- ---.._------......-......-----------------. <br /> (Draw existing and required addition on reverse side) <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 San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: - <br /> ' "1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner <br /> as to become blect to Workman's Compensation laws of California." <br /> Signed .......: .c a !t%.`C�.`.. :. Owner <br /> By .............................r ti. - ed Title ----- <br /> (if ----__ --- -- ------------------- <br /> other the o ed � - <br /> FOR DEPARTMENT USE ONLY <br /> ' APPLICATION ACCEPTED BY ....... -------.P�'a---_-----------..... .. ............. ............................ DATE .... 0-..:: :2Z'---•---- <br /> BUILDINGPERMIT ISSUED ..........--............... .......-----................................................_1..............DATE ............. ......._.................... <br /> ADDITIONALCOMMENTS -----...._............ - -----------------------------------•----------------------------------------------------- _-...-•-......•........ <br /> ............................................................................ ......................................... ........................................ ...... .................. . . ... -- <br /> 1 - - ----------------------------------------------------------------------- - - ------ ----- <br /> - .......... --- . ....... ----- . <br /> - ---- -- - Date _. —1-�.��.. <br /> Final Inspection by: -------- - - - - ................................... <br /> ' SAN JOAQUIN LOCAL HEALTH DISTRICT yam. <br /> F H. 9 _7-'AR RPv SM' C� 'v <br />