Laserfiche WebLink
r�r FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT L 6 <br /> - Permit No: - <br /> �I.3 (Complete in Triplicate) <br /> ____---- This Permit Expires 1 Year Froin Date Issued <br /> Date Issued .:.�_..:..�. <br /> 2-0-e /V - r-r( fi Jc c )�4-Y �f IF -- 3!4 �O <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 compliance with County Ordinance No. 549 and�exi�sting Rules and Regulations: <br /> JOB ADDRESS/LOCATION �/ �P/.--.61px--� ----9-- 'f,'/t6�ye,--/tiG�-xNSUS TRACT <br /> Owner's Name � �-e ------------..------- 6-Y -0 <br /> Phone ----­------------------------- <br /> ------------------------- <br /> 407 <br /> - - <br /> Address �,�--'---lax � ' �------------------•--- ------------. City - �i�Cp=Gr ------------------------- <br /> Contractor's Name o �' /C "-------------------------- __ ._.License # - - -- -------------- Phone _... .------ <br /> Installation will serve: Residence []Apartment House❑ Commercialolrailer Court ❑ <br /> Motel ❑ Other ...... - ........................... <br /> Number of living units:."'_--- Number of bedrooms .'....Garbage Grinder�/Q. Lot Size ��`. ......'k------------------------ <br /> Water Supply: Public System and name ........ . ... ...............__........ _.------.--------................._..--.---.---------------- PrivateX CK <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe ] Fill Material ............ If yes, type --- -__._--- e <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 /> PACKAGE TREATMENT [ ] SEPTIC TANK X`J Size. �,l�i �. _-____._. Liquid Depth 1t�_. <br /> Capacity 1.2e—e.--- Type /`��I Material. i l "`.. No. Compartments --- _-__----.-- <br /> Distance to nearest: Well .-__ ._19,x_ _._-__.-.Foundation _ 70/- � <br /> ,�" -----.-- Prop. Line,/__-�_--__-... <br /> LEACHING LINE No- of Lines -----/­ __ Length of each line_etl--------....__.. Total Length ( .----------------- <br /> 'D' <br /> 'D' Boxf ?_ Type Filter Material Depth Filter Material / ................................ <br /> Distance to nearest: Well ZOV7._' ---- Foundation � ----....._. Property Line .-...- 9 <br /> SEEPAGE PIT 4CJ Depth Diameter � s�----- Number __ ................... Rock Filled Yes, No ❑ <br /> c0l, <br /> Water Table Depth --__ r -. -� Rock Size ----------------- <br /> Distance to nearest: Well .._. _____---------------Foundation ...... Prop. Line ....... <br /> / REPAIR/ADDITION(Prev. Sanitation Permit# -------- -- .................---------- <br /> Date __--.-_-_______ .............. <br /> Septic Tan (Specify Requirements) __ _,____.__-_.- -- ............... <br /> ••------••-------------------•--------------- --... <br /> Disposal Field,(Specify Requirements) ------------------------------------- ------•---•------------------•----------------------- <br /> 1 = <br /> ----------- - ----------- ------ ------ -.... _... <br /> or (Draw existing and required addition'on reverse side) <br /> f I-hereby certify that 1 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 t6-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 become subject to Workman's•Corriperi3aflon Iciws of-California." <br /> Signed -- ------- - U ---------------------- ------••••-• Owner <br /> ' /r ---------E'- ---------------- ----- T --- <br /> itle <br /> ---- --------- <br /> BY ? r <br /> f other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY :--- ��:.-,! %4W..........--............................................_.......... DATE -----•---•----•---------- <br /> BUILDINGPERMIT ISSUED ------- --------------------J­•!--------- --•------------------------------ - .-.-.DATE ..-•••----.....-----•---•••.. ............. <br /> ADDITIONALCOMMENTS ------------------- ...........------------------------_._.........-.-._.................................. .........-•-..................................... <br /> -................ ------_...-•.... ............................. ............. ....................................... ........................... .......................................... <br /> ...............•••----------•_........ ......................... ... ................................. ............................................. . . . ..................... <br /> ------------------------------ ----- -_ '._...... --••---••...---.......---•-.-•-•••-•-••---------•-•- ..__.. <br /> Final Inspection by: ..--.------ -' Date _� - <br /> �`` + AQUIN LOCAL HEALTH DISTRICT _ K •- - <br /> F H 9 1-'OR RPv <br />