Laserfiche WebLink
FOR OFF-ICE RUSE: ? 1 <br /> APPLICATION FOR SANITATION PERMIT <br /> ................................................. <br /> ` tcamplete in Triplicate) Permit No.�� <br /> This Permit EZpires 1 Year From Date Issued Date Issued f--7_f7S_ <br /> Application is hereby mode 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 witI County Ordinance No. 549 and existing Rules and Regulations: <br /> Na_�me_ - .. CENSUS TRACT ::... . ....... <br /> .......: --. -. . ..JOB ADDRESS/LOCATION D,�_. _ .,.. � a��, �- qns__Ale <br /> .� _ .. <br /> Owner's .-_. ,. :.L:_�..:..- - �, .�2, .......... ...... .................... <br /> Address .........:.......a ... �'_. � _---------- -----•-- - City <br /> .w <br /> Contractor's Name ...i�: R_I 6 A� '1�1. -._ �W .... C_.---------license # ....................•_.. Phone <br /> Installation will serve:. + Residence WApartment House 0 Commercial [-]Trailer Court ❑ <br /> Motel ❑ Other .- <br /> Z d� <br /> Number of living units:-. ,... Number of bedrooms : _..... rbage Grinder .._..... lot Size .�.5 _r.. .................' <br /> I -r/ . _ Private Water Supply: Public System and name _....._ ---------... =- ❑ <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loa , r Clay Loam <br /> f E <br /> Hardpan ❑ Adobef Fill Material ...._..._,_. If yes, type ........ .. ................ <br /> Z. <br /> i (Plot plan, showing size of lot, location of system' in relation to welts, buildings, etc: must be. placed on reverse .side) <br /> E NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) i <br /> ( PACKAGE TREATMENT ( } SEPTIC TANK j } ji Size------------ -- --•----:.----.--......... Liquid Depth ........................... <br /> Q <br /> L � i <br /> C <br /> Fa Capacity ! __.... Material ....... No. Compartments_ -� -- ----..,•Type _._.[.._._.._ -- - - - P ...................... <br /> Distance to nearest: Well ., ----------------Foundation _..._:..._... _---.:_.. Prop. Line ---------............. <br /> LEACHING LINE [ J No. of Lines Ll,6ngth of each line- :..-- .......... Total length ____________________-._ -- (� <br /> 'D' Box ...... .... Type Filter'Material .._. ------ ........Depth 'Filter Material .......... ------...............:_-.---__ a <br /> Distance to- nearest: Well _.__..,' :.: _ .__. ._ foundation _.. ........ Property Line .........:............:4 <br /> ' SEEPAGE PIT �` <br /> [ j Depth Dinmeter� Number ., .-..:4 _.....-.-- Rock filled Yes ❑ No Q <br /> Water Table Depth __._.:"_..,.-.----------------------------------Rock Size ..,_...-._....---...__:_-------- <br /> Distance to nearest: Well -----..._€-------------------------------- <br /> Foundation ........ . ----- Prop. Line .._.._.. ......... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------- -----,._ .-----. ..--•------- 'Date --_-----.'_:.-------.-----_--- --) <br /> Septic Tank (Specify Requirements) ...:. .. . ._. -.:_ :.._. -:. .. ..__.....:..... ...... ........._......._.. .. .-.-_..._,.._. .... <br /> Disposal Field ecify Requirements] -_._ I� -� - , --.------------------- ••-.-•-------• <br /> t C� <br /> - _. --------------- - . ---- ---------------- <br /> _A ` �- <br /> �t <br /> (Draw existingand"required addition on rev se si e) <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 /> "I 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 be a suble Workman's co nsation laws of California." <br /> l� <br /> Signed ..► .I�?-21� � NS' _ r <br /> a By .. ....... .. - , •— Title . <br /> (If other than owner) <br /> t <br /> FOR DEPARTMENT U!V, ONLY <br /> APPLICATION ACCEPTED BY -----�­ ........ ......... DATE _.. ...... <br /> BUILDING PERMIT ISSUED -- DATE ...._.. _..: <br /> ADDITIONAL COMMENTS ------------ ---- ------ '... ------------------:.................. <br /> i <br /> .......................................... .... ..:....•__._._.___ _.._-___.................._... ._ ._._._.-....._.._.......-...,..........._......._..____.............................. ........ <br /> ......................... ....... .. ._ ..__------_______-- .... .. <br /> Final Inspection b <br /> P Y: ....... . - - •------•---------'- - •- ------ ------ ................................Date ...t�V�...---- --��•••�--=� -...-- <br /> j` IY <br /> SAN JOAQUIN LOCAL HEALTH. DISTRICT <br /> t <br /> a <br /> % F. H 1.3 24 1-'AA Rav sM M --. : 7/12 3 if <br />