Laserfiche WebLink
APhLI <br /> FC3R OFiaCE liSl: CAXlON FOR SANITATION PERMIT . <br /> .�;. ..... .... ......... . i Permit No ............------- <br /> (Com plete in Tripllcate) <br /> i e <br /> - -------..... .................. Date issued :Z% <br /> This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to th San Joaquin Local Health District fora permit to construct and install the work herein <br /> described. This application is made in compliance with-,county,pedinance No. 549 and existing Rules and Regulatigns: <br /> ?-c. ...........:.................. ..CEN <br /> JOB ADDRESS/LOCATION ,10T�� <br /> Owner's Name .............. 6.......�.. ..�-� .-' �..,. . Phoned_-.f„ ,r ....... <br /> Address / .cj:3 : z.Ga ? ..:city ..... .. <br /> Contractor's Name <br /> -• . . ....:.....: ..LicenserJS . ' .... Phone <br /> Installation will serve: Residence)gApartment House] Commensal SNOW Court O <br /> Motel t]Other . --•-- ......:_. . " .__ �. <br /> . l ;.....Garbage Grinder ......::: .: tot.Sura ........1 � � <br /> � Number of living units:_•--.--•...: Number of bedrooms .. •... .- . .. .... ... <br /> Water Supply: Public System andname •------ ....................__....... '..--'`., ....................................1.. .Private <br /> Character of sail to a depth of 3 feet: Sand 0. Silt❑ Cloy► ❑ Peat Q Sandy Loam Q Clay Loam 0 ` <br /> Hardpan p Adobe Fill Motorial ............if yes.type..........I.... ........ <br /> (Plot,plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed an revere side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200•feet,) <br /> PACKAGE TREATMENT ( ] SEPTIC TANKIK X..� ......-•.................. Liquid Dwh I..5 <br /> Capaci /�aQ Type :+t�g�-•... Material... <br /> :: No. Compctrtrr►eMs ..._..2:..........� <br /> Distance to nearest: Well ..._..1Q4?.....................Foundation ../..Q...t _..._...: Prop. lin .............-.°Q <br /> f 0i <br /> LEACHING EINE ] No. of Lines -- If <br /> i.--:_Y._.._..= Length of each line.---. f.:..::...... Total Length ...................� <br /> B8 <br /> ✓. . Type .Filter Material .................................. <br /> °:. � Depth filter Material ....,� ....� <br /> 'D' Box .._...... <br /> r . Distance to nearest.Well ..../_4-..'.�e. <br /> Nuf. <br /> .. Foundation ..../-Q.............. Property Line ... .�..__.......:. <br /> SEEPAGE P T � Depth �.._.. Diameter �,� mber ...:...._ _._.....�..... Rock filled Yes � No Q� <br /> Water Table Depth .....Rock Size <br /> c' Yr-�..............� . <br /> :# c <br /> Distance to nearest: Well ......._1 . -•-:---._..._._......Foundation'---lQ..�`..... Prop. line .. . . <br /> 1 <br /> •. �1t <br /> REPAIRJADDITION{Pray. Sanitation'Permit# <br /> ......... .. ...............:.... oats ----........_........ ............ <br /> Septic Tank (Specify Requirements) ----•................... ...�.......-----:..:..........r::.-..:.w-•• ..................I.,............................. <br /> Disposal Field {Specify Requirements} ` ... ......... ........... ..... <br /> ---------- --------------------------------------------................... .................... •-----•---------•••....._.----__..... ...... <br /> ...................... <br /> ............... <br /> (Drawexisting_and required additionoh,reverse sldel=-. <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with Sen 300411uln <br /> County Ordinances, State Laws,,6d Rules and Regulations of the San Joaquin Local Health-.Disyrid. Hanle owner or Been. <br /> sed agents signature certifies the`fallowing: <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 subject to Workman's Compensation laws of Califenda:' . <br /> l <br /> Signed ......... .............- -- Owner <br /> By ........... . %- - ------ --- Jitfe lJ..=.:. <br /> Of oche an owner! <br /> _v FOR DEPARTMENT,USE ONLY <br /> --------- DATE ,._l.: -.7.�.............:. . <br /> APPLICATION ACCEPTED BY ------- --- ----- -------------------------------- <br /> BUILDING PERMIT 15SUED * --------•------------------------------------- ------------ -- DATE . .................................... <br /> ADDITIONAL COMMENTS -----h4. ..:-. ---� ._.__....:.............•----__ <br /> ....... <br /> { ............ . . ­1"...", <br /> ..------.._...... ....................... <br /> ------------------------------ ._-•-------•--- ---.......-... ,...-._.._.-..._....._.. ------. :..., <br /> -------------------------------- -/ VA <br /> Final Inspection by_ ______________ Date .. . ..._... �........... <br /> -- --. ._.._.... - --•---------_-- -•---...----... ... ..... .. ..... . .. . ........ e -.f EH 13 .2h 1-68 liev. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 83M <br />