Laserfiche WebLink
(Draw:existing a —nd required addition <br />I hereby certify that I have preparedtHirs applicat °Wand that the work will be done <br />% <br />County Ordinances, State Ilves, and 'Rules at5i1 Re1 actions of the San Joaquin Local Health District. Home owner or licen- <br />sed agents signature certifie's the following: --"-- i <br />"I certify that in the perforAance of the-work forwhich this permit is issued, I <br />as to become subject to Woirkman's Compensation laws of California." <br />on reverse side) <br />In accordance with San Joaquin <br />shall not employ any person In such manner <br />APPLICATION FOR SANITATION PERMIT <br />(Complete in Triplicate) <br />This Permit Expires 1 Year From Date issued <br />, . <br />Permit No. <br />Date Issued <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 existing Rules and Regulations: <br />i! —...... „ 1 <br />JOB ADDRESS/LOCATION I Ri 97e3 a- ti a A.8.07" .4.49,0, <br />Owner's Name ..e..e_. .,_, e---- <br /> License #,/ x• e.A. Phone z..0.-.7...zize <br />ResidenceAApartment House° Commercial 0Trailer Court 0 <br />Motel ID Other <br />Number of bedrooms A.7 Garbage Grinder 4e, Lot Size <br /> PrivateA <br />_ <br />.(Plot plan, showing size ofi lot, location of system in relatibn to wells, buildings, etc. must be placed on reverse 1 <br />(Noseptic tank or seepage 'pit permitted if public sewer is available within 200 feet,) / i <br />[ 1 1 ' SEPTIC TANK pg - , Size.VX 9 ' (.1— Liquid Depth <br />... <br />Distance to nearest: Well..igeo. 1 Foundation Property Line AV <br />DeplIth ept 11 <br />Date ...... <br />Owner <br />Title . .... Signed <br />By ....... <br />(If , er than iownerl <br />FOR DEPARTMENT USE ONLY <br />Address /72 ......... ...... City <br />Contractor's Name <br />Installation will serve: <br />Number of living units:. <br />Water Supply: Public System and name . <br />Character of soil to a depth of 3 feet: Sand '0 Silt!: Clay 0 Peat 0 Sandy Loam -0 Clay Loam .0 <br />Hardpan,. Adobe 1 Fill Material if yes, type <br />side.) <br />,...NEW INSTALLATION: <br /> <br />....-II. , c <br />2.7 il . <br />... ••••••••• <br /> ••I Septic Tank (Sp ecify Requirements) t <br />././ Disposal Field (Specify Requirements) . I El ..., • • _ . • ... ... <br /> <br />i: a .... <br /> <br />4 <br />PACKAGE TREATMENT <br />Distance to nearest: Well .0" t.,* Foundation ga . <br />REPA1R/ADDITION (Prey. SalLtation Permit # <br />Capacity/Zea..... Typret4,,46. Material e-- No. Compartments <br />Distance to to nearest: We 1 .Foundation Prop. Line ea. <br />Diameter .3,9 NUMber Rock Filled Yes,' No (:) <br />Water Table Depth <br />ifor <br />No.' of Lines _ Length of each line t'.'e;V° iotal Length .4.4f9R <br />• <br />'D' Boxi(.40..... Type Filter .Materici14/611Depth Filter'Mdterial /1"`"" <br />I I Rock Size/ "*". "" <br />Prop. Line .7110.— <br />APPLICATION_ACCEPTED BY <br />I BUILDING 'PERMIT ISSUEDni <br />ADDITIONAL COMMENTS <br />. DATE <br /> DATE <br />4 <br />ss41 <br />vi • <br />Foe. OFFICE_ USE: _ <br />SUS TRACT <br />Phone <br />,LEACHING LINE J,AT <br />.t <br />:„.SEEPAGE PIT /h4 <br />Nv.N. <br />SA4 JC5-AQUIN LOCAL HEALTH DISTRICT <br />Dater- .... <br />Li <br />.... ..... .1 • • <br />Final Inspection byi <br />E. H. 9 1-68 Rev. 5M ••••••••,..,