Laserfiche WebLink
FOR.OFFICE USE: <br /> 4PPL t — -MT'; oN PE, _,SIT �j <br /> ----------------------------------------- 4 <br /> (Complete in Triplicate) Permit No.79-_ 0__t. <br /> ----------------------------------------__--------------- This Permit Expires ] Year From Date Issued <br /> Date Issued 7/7_— <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 Count rdinance No. 9 and existing Rules and Regulations: <br /> JOB. ADDRESS/LOCATI ---------------CENSUS TRACT ____._______ ........... <br /> Owner's Name ------p�---.-- --��,--„----------- -r�3. Pho a7"01-`37Q <br /> -- �-=L- �1. / - ----------------- Cit <br /> Address .--- --� i --------- -- -- --- -- Y <br /> -- i ----------------------------------'------'------- er c __�I__ Phoi1E <br /> Contractor's Name License # .-.--_ <br /> V 0 <br /> Installation will serve: Residence Apartment House Commercial Effrailer Court~ �I <br /> "Motel ❑Other" ,���o�____C'•�wr_�.. Y <br /> Number of living _ ev <br /> units:__�__'_,w,Number of bedrooms ___7----Garbage Grinder ____________ Lot Size --- __________________ <br /> � <br /> Water Supply: Public System and name -------------------------------•-------------- ----------------------------•-------------------------- -------Private�V <br /> Character of soil to a depth of 3 feet: Sand' 'Silt❑ ❑Clay ❑ Peat` Sandy Loam ❑ Clay Loam <br /> Hardpan Adobe Fill Material ------------ If If yes,type ---------------------- ----- <br /> (Plot plan, showing size of lot,. location of system in relation to wells, buildings, etc. must be placed on reverse side.) W <br /> NEW INSTALLATION: (No septic tank or seepage pit-permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT SEPTIC TANK [ ]3 Size- �-ix-- - --------------- ------------ Liquid Depth ---- /r__------ # <br /> y <br /> �lp� Capacity2 _ �_ Type -1 �7`____ Material__ .r- No. Compartments r____�a___---_____ <br /> JL7r,49#710N 04"TS Distance to nearest: {Well _________________ R_:__.___________Foundation __l�_��`-------- Prop. Line -- �� _--__ �. <br /> LEACHING LINE No. of Lines ------- ' '------- _ g - D /�__ ---- g <br /> .' -. _ ------ --------------------- <br /> t ,•'D' Box ---I--"*"- Type Filter Mater) 1 o�each„[ine- epth Filter Ma#er ala) Length _ .t__ I <br /> `Distance to nearest: Well ------------------------ Foundation ----f 0_._"r`-__ _-Property Line - � ..__._.... <br /> SEEPAGE PIT [ ] -' ,Depth -------------------- Diarnete -___-_--._____ Number _______,.__-,.___ ----- _;Rock Filled Yes ❑ No i❑ <br /> -Water Table Depth ------------------------------------------------Rock Size ----F-- -------- --------- <br /> Distance <br /> ------TMDistance to nearest: Well ----------------------------------------Foundation ----'!-------------- Prop. Line _..._--.__... ........ q <br /> REPAIR ADDITION(P . ganitation'Perm_it�.# -------------------------------------------- Date ------:-- ---__-__- _--t- <br /> Septc-Tank' SecifwReuirements) ----------------------------- -------------------- - ------- - -+:--.-.---.-.---�--i-°}-- <br /> '- <br /> -•----------------------------- <br /> Disposal <br /> Field-.(Specify Requirements) --=------- <br /> -------------------- --------------------'"1 <br /> r� s <br /> ------------------------------ - <br /> -------------------- ------------------------ <br /> Q A4 <br /> -------------- -------------- <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared thispplication 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-Disteict. Nome owner or licen- <br /> sed agents signature certifies the following: ' _­ __ — 4 <br /> "I certify tttaYin the perFormance of the woik for which this permit is issued, I shah not.empfoy—any in such manner <br /> as to become subject to Workman's Compensation laws of California." ; <br /> Signed ---- <br /> By <br /> -- <br /> BY - _ - <br /> t Owner <br /> ---- -- <br /> --- ------------------------------- ------ Title ---------- ----- r� <br /> (If other an owner) <br /> FOR DEPARTMENT USE ONLY -- <br /> APPLICATION ACCEPTED BY --- ---- ----------------------------------------- ------------- DATE <br /> BUILDING PERMIT ISSUED -- pP riacX-`�--7�-V�------------------ -------- --DATE Al-7�7-'r- ----- , <br /> ------- <br /> ADDITIONAL COMMENTS '= <br /> -------------------- ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------ <br /> __________ ____ ______ -------------- ------------------------ -------------------- ----------------------------------------------__----------_---._-._ q <br /> _______ ____________________ ____ ___ ___ - ---_--. __.___ ____ __________________ <br /> Final Inspection bY: ----- -- - ------ - } - ---------Date ----- <br /> SAN JOAQ IN LOCAL HEALTH DISTRICT <br /> 5� <br /> E. H. 9 1-'68 Rev. 5M <br />