Laserfiche WebLink
.....:......... .. . -- ---• APPLICATION FOR SANITATION PRRMiT —� <br /> ..........-........................................... ICompleteln Triplicate) Permit No. ... <br /> 77..: <br /> ....................................... This Permit Ex 1 Year <br /> phw From Dote Isiwrl+ <br /> Application Is hereby made to the San Joaquin Local Health District for a permit to construct and Install the work heroin <br /> described. This application Is made in compliance with County Ordinance No. 549 and existing Rules and Regulations, <br /> JOB ADDREStAOCATION ..t�}� �'�•� ` .. ...r! tt'. _ �',p �...,.:..'':'.....:' . <br /> .. .✓�• .. .._CENSUS TRACT <br /> Owner's Na �,e ..!! ... .. ... ...................... ............ ... ......Phone .. ..........5��.............. <br /> Address r .-:Z. ............................................•City, .�!Gr�..... .................... <br /> ............ �. .. ... <br /> Contractor's Name .. <br /> .,... .............................................license 0o�. .. Phone• .ul..: ,��•,,� <br /> Installation will some, esideZ ortment House t] Commercial QTralier Court Q . <br /> f Motel[3 Other _ <br /> Number of living units: ........... Number of bedrooms .9--Garbage Grinder• <br /> ..e ........... Lot Size ............ ._..................'.... <br /> Water Supply, Public Syttem and name .... _...................._._ .' <br /> .. <br /> Character of soil to a depth of 3 feets Sand Q Silt Q Clay O Peet Q Sandy Loam Q day Loom Q <br /> f' s ,Hardpan Q Adobe Q Fill Material............if yes,type.............. .......... <br /> (Plot plan, showing':ize of lot,.location of system in relation to wells, buildings, etc. must be placed an 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 •... Liquid Depth <br /> ---.--r._ Sire. _............ . ... <br /> Cop Mabrinl.l '. tL No. Compartments .. -: ..... <br /> Drstar,ce.to rnearest: Well ...�8 ..:..,�_.......1......Foundation 1 .:............ Prop Line .». <br /> LEACHING LINE . ...................... Len <br /> gth of ock:h fine.',,7 Total Length A=140...`-.......». <br /> 'D';Box•�.M.r. Type filter Material ..::Oe'pth'Fllter 1410ferinl:ems- :��:. .. ,1 <br /> • , <br /> Distance to nearest, We ..?.1.4!�...-.,,, oundation .�:..:..':.;'::"':^property—Line ...,r'�...,.1�...�. ... <br /> t <br /> SEEPAGE PIT [ j Depth' .................. Diameter +_--:—Number• Rock Filled Yes Q No <br /> Water Table DaA� ................ .......... ..................Rock Size�............... � <br /> r i Distance to nearest, Well ................................ <br /> ..... -Foundation.......--••---..:.... Prop. line .....»....�-- <br /> ..... ... ».^ <br /> REPAIR/ADDITION jProv. Sanitation Permit.# . . Data <br /> Septic Tank (Specify Requirements) ...........................i ^ T...... .........~...__».«_......., <br /> ..................._............. <br /> Disposal Field (Specify Requirements) .............................. .................................................... •.� <br /> .........................................................................._..................................._.....................7.......................... <br /> ... •.. <br /> .................................................................. <br /> existing and required addition on reverie side). .. . ... . .. . . . ...... ... <br /> ............ <br /> 1 hereby certify that I hairs prepared this application and that the work will be done In accordance with ISm Joaqule <br /> County Ordinances, Stale Laws, and Auloi and Regulation: 11 the San Joaquin Local 'Htatth District. Home ewner or Ncen• <br /> sed agents signature certifies the iollowing: <br /> "I certify that In the perforrmonce of Iks,v+ork`Nw-W-hich-this-pennit•1s issued, I shall not employ any person in such manner <br /> as to become subject "orkman's Compensation laws of California." , <br /> Signed .. a ,... ........................... Owner <br /> By......... . , <br /> y ............ ... ................ �t��1..............__........:Title ••-......•..---.............. <br /> (If other than owner <br /> ; <br /> R ART ENT USE ONLY <br /> APPLICATION ACCEPTED BY........... DATE ........G 77. <br /> BUILDING PERMIT ISSUED......•....... .•.- .. <br /> ADDITIONALCOMMENTS ................................................ ............._....-........... OATi:............:......... ....... ........... <br /> Fin"a : .•..•............... �-..... ... ... ........-.....-...... . <br /> l Inspection by ......... .. - --........-........-....... ..................... . . .................................. <br /> EH1-3 ............. .............................•.._.. ..Dale • .I .....-.•............ <br /> 24 1-6A Rov. .9f SAN QAQUIN LOCAL HEALTH DISTRICT $/?h 3fI <br />