Laserfiche WebLink
c �s <br /> S <br /> I''OR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit No: <br /> f (Complete in Triplicate) k <br /> ------------ <br /> Date Issued <br /> This permit Expires 1 Year From Date Issued <br />----- - -- ----------- <br /> A lication �s hereb made to the SFI Joaquin Local Health District for a permit to construct and install the work herein <br /> desperibhereby ed. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> Z 3 - f� --------------- ---------CENSUS TRACT <br /> JOB ADDRESS/LOCATION -- --- �-----� ---:�-- --�-�-�-C��------ ---------- <br /> Owner's Name -------- ARTHUR i-Q-!'►A_------- R'------- =- --- Phone �' <br /> ----•- <br /> -- -f�- ► Poi------- <br /> Address -----�._��_'10-1.6-------•s--------1 'I-14-C- }-� Cit <br /> --- -- -------------------------- - <br /> ---------------- <br /> Confiractor's NameQ1tSIN ` f------- <br /> License # --------- -------------- Phone ------------------------ -•-- <br /> Installation will serve: Residence X'Apartment.Housef­l Commercial :❑Trailer,Court ;❑ <br /> €,�Motel ❑ Other -------------------------------------- <br /> _ -----•- <br /> Number of living units:....(_------ Number of bedrooms 3-------Garbage Grinder ---____ Lot Size - CREGy <br /> Water Supply: Public System and name ----------------------------------------------------------------------•---y--- --- ;----•---•------------••- <br /> Private X , <br /> Character of soil to a depth of 3 feet! Sand'❑ Silt❑._ Clay ❑ Peat❑ Sand Loam� Clay Loam j] <br />. syr - <br /> Hardpan ❑ Adobe ❑ Fill Material f1--- If.yes,t�rPe --------------------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) 11 <br /> 3 ;A, i r" <br /> NEW INSTALLATION: (No septic tank or seep ge pit permitted if public sewer is avai hle-"within 240 feet,} <br /> PACKAGE TREATMENT [ ] SEPTIC TANK:[ ] Size------------------------------------ ----- Liquid Depth --------•-----.------.---•- <br /> Ca aci T Pe Material No. Compartments ....--•--- <br /> p <br /> capacity ------------------ Q <br /> Distance to nearest: 11 ------------------------------------Foundation ---- ----------------- Prop. Line ----------.---------• <br /> LEACHING LINE [ j No. of Lines ------- Length-,of each line----------------------- --- Total Length ------------.--------:---•-- <br /> ---------------- <br /> -- A <br /> 'D' Box ------ Type Fi ter Material --------------------Depth Filter aterial --------------------------------- <br /> Foundation --------------- ------ Property Line. --------- -----•-------- <br /> Distance#o nearest: We I -_--___-__----_-_--_ . <br /> SEEPAGE PIT [ } p --- Di meter, --------M'!` Number-____:-------------- "------ Rock Filled Yes ❑ No I❑ <br /> Water Table Depth - ---------- -------------Rock Size ------ ; ------------- -- - 1 <br /> Distance to',near6t We -- 1 ---Foundation --- --------------- Prop. Line ----------.____--_-- <br /> _ <br /> i <br /> REPAIR/ADDITION(Prev. Sanitation'Permit# T Date`________________x <br /> Septic Tank (Specify Requirements} _-__--� - ---- - <br /> ply-- - t------- AffQtTI_o. __------------ --- -------------------------- <br /> tW� — ----------- <br /> Disposal Field (Specify Requirements) -jD�-��T--- _` `�'"� �I - i.1 � �� t <br /> f-# � AI- -------- 1�-6r14rt---14-► F-- ��-� =8� --PV <br /> ---. -----�-- ----------------------- <br /> -----=----- <br /> (Draw existing and required addition on reverse sfdel� <br /> 1 hereby certify that 1 have prepared-this-application.and..th.at_.-the-work will be done din accordance with San Joaquin f <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 the following: <br /> "I certify thsl i herforma e f the work for which this permit is issued, I shall not employ any person in such manner <br /> as to bee s j to Work i �s as laws of California." <br /> j <br /> Signed - _ Owner j <br /> �_R-Q.-------. Title ----- --------------------------------------------- -------------------- <br /> (If other than owner) kA k <br /> w FOR DEPARTMENT USE ONLY <br /> k APPLICATION ACCEPTED BY � `--------------------------------•--- ------------------------------------- DATE . -'. 7/---------- <br /> Y <br /> BUILDING.--PERMIT- = -- --: . _ _ DATE -- =_— = == = ".--.. . <br /> ------------------ <br /> ADDITIONAL COMMENTS --_-_-__-- -1 _,,., -- �. � -�� <br /> -- -------------- ---------- -------------------------------------- <br /> -- A 4— <br /> = ---- --- <br /> i i�i ���it { 1 _.`. , <br /> ._- . __ - - <br /> ------ _ _ <br /> - -- -- - - -- ------ <br /> t - <br /> i Final Inspe ' by: ----- ---------- <br /> Date <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 - -1-'68 Rev. 5M <br />