Laserfiche WebLink
Permit No. <br />Date Issued ,22J <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 />JOB ADDRESS/LOCATIO . 02/ 3.73 71- ir CENS ,JS TRACT <br />Owner's Name <br />Address &f' _E- .A.se City ....-404.1fly•r#2 <br />Contractor's Name <br />‘...e.tec.,:zoi License# / .4 1 .3. i ' 7f7: Phone <br />Installation will serve; Residence Apartment House 0 Commercial °Trailer Court 0 <br />Motel 0 Other <br />Number of living units:.../ ...... Number of bedrooms 43 Garbage Grinder Lot Size iir4-41. 4 4 ° <br />Water Supply: Public System and name Private El— <br />Character of soil to a depth of 3 feet: Sand 0 Silt 0 Clay 0 Peat 0 Sandy Loam ar-- Cloy Loam 0 <br /> <br />Hardpan 0 Adobe Fill Waterial If yes, type <br />OMB <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 wit lin 200 feet,) <br />Size Lk uid Depth <br />Capacity Type Material No. Compartments <br />Distance to nearest: Well Foundation Prop. Line <br />LEACHING LINE [ ] No. of Lines Length of <br />'D Box Type Filter Material <br />Distance to nearest: Well Foundation <br />SEEPAGE PIT [ ) Depth Diameter Number Rack Filled Yes :._, I—I No CI <br />Rock Size <br />Distance to nearest: Well Foundation <br />REPAIR/ADDITION (Prey. Sanitation Permit # Date <br /> --4" <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 ac:ordance with San Joaquin <br />County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health D strict. 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 become sublect to Workman's Compensation laws of California." <br />efr 6Va :rifle <br /> Owner <br />FOR DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED BY 477: <br />BUILDING PERMIT ISSUED DA YE <br />DA .... <br />ADDITIONAL COMMENTS <br />PACKAGE TREATMENT [ I SEPTIC TANK{ <br /> <br />each line Tote I Length <br /> Depth Filter Material <br />Properly Line <br />)-) <br />co <br />7 <br />Water Table Depth <br />Prop. Line <br />Septic Tank (Specify Requirements) <br />Disposal Field (Specify Requirements) <br /> I 2- <br />Signed <br />By <br />(If other other than owner <br /> <br />FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br />(Complete in Triplicate) <br />This Permit Expires 1 Year From Date Issued <br /> <br />Final Inspection by: <br />E. H. 13 241'68 Rev. 5M <br />Date <br />Crf <br />7/72 3 14 <br />SAN JOAQUIN LOCAL HEALTH . DISTRICT