Laserfiche WebLink
FOR OFFICE USE: <br /> APPLICATION POR SANITATION PERMIT <br /> {Complete in Triplicate) -----. ... . •... .. <br /> Permit No �� SO <br /> S <br /> ..... . ..................:......... This Permit Expires I Year From Date#saved bate Issued ........._.... <br /> - - � <br />' Application Is hereby m e to the San Joaquin Local Health District for a permit to construct and Install the work herein <br /> k describ d, T/hl a lic n N lionce with County Ordi nce No. 549 and existingrRules and Regulations: <br /> I 'J;Z�RESS/L 10 .. .. . i © �C� <br /> , ENSUS TRACT <br /> Owner's Name ......... .. ? .� NVf f �,>... - <br /> �` Phone ... .. <br /> Address .........c .. ..... . .......�Q .. l�'.C... . ..............rCity . .0 s4. ./ ................................. <br /> r <br /> Contractor's Name .... 1! 1,j.3-{. ....�J, License #A578' �•... phone .0Y27/2 <br /> installation will serve: Residence brApartment Houseo Commercial QTraller Court Q <br /> Motel Other <br />'F <br /> Number of living units:----------- Number of bedrooms . ..Garbage Grinder .......... Lot Size .../ .. <br /> ........ ........ <br /> Water Supply: Public System and name <br /> ............. .........................................:. .......Private) <br /> Character of soli to a depth of 3 feet: Sand Q Silt❑ Clay Q Peat Q Sandy Loans k Clay Loam ] <br /> .,. r. Hardpan Adobe Q Fill Materlal ............ if yes,..type.:........... ._.:......_... <br /> (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed an reverse side. y <br /> NEW INSTALLATION. (No septic tank or seepage pit permitted If public sewer is available within 200 feet,j <br /> �y <br /> PACKAGE TREATMENT,,,[ ] SEPTIC TANK$ ] t Size.... ........ Liquid Depth <br /> ..............._ ......... <br /> P Y <br /> Ca acct # Q Typ PJ1�;Material.. '± ? o. Compartments �� <br /> Distance to nearest: Well .....K's-0.------------------Foundation 7 i <br /> .-�.. .............. Prop. Line -� .�..... <br /> LEACHING LINE [ ] No. of Lines .... ............. Length of ea line._.. ..... . Total Length g ..,�. �......... <br /> 'D' Sax ..: ........ Type Filter Material �} <br /> � .�. ........__Depth Filter Material ....o�».�.f i................ <br /> Distance to nearest: Well ....I: <br /> ............. Foundation ..... .._.... Property Line .�®� � . <br /> SfIrP„� PET [ ) Depth ...._ � t� .. Number <br /> Diameter -1 :................. Rock Filled Yes ' No Q <br /> i <br /> Water Table Depth Rock Size <br /> Distance to nearest: Well ...... ..................Foundation Q Prop. Line <br /> REPAIR/ADDITION jPrev. Sanitation Permit# ................................ . Date -: <br /> Septic Wank (Specify Requirements) ....................._........... ..................... <br /> .......:........................................................ <br /> Disposal Field (Specify Requirements) <br /> ............................................. ....................... •-----.-........-------................---............ <br /> ............................................................. ..........-................................................I......I............... <br /> .. <br /> ............•....................... <br /> (Draw-existing and required addition,on reverse side) <br /> I Hereby certify that t have,prepared this application 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 District. Home. owner or Ilcon. <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 beco ubj ct t W man' ompensatio s of California." <br /> Signed .. ..........I...... .... -.. Owner <br /> ..------- ---•..................... <br /> By .._. . .r <br /> $ 64 <br /> # ,� . title ........ _.. <br /> If other'thon owner);11 <br /> i I R .DEP RTMENT USE ONLY <br /> APPLICATION ACCEPTED SY.._.011 <br /> BUILDING PERMIT ISSUED ............ ..... ...... .. . ... ..... ... ........................................................DATE ........... <br /> . �..- <br /> ADDITIONAL COMMENTS <br /> :................................................................Qls�.._... TE.................... ..._....----- { <br /> .._.._.. ................................................ ...I............__.......... , .........._........_....... ........................................................... <br /> ... <br /> Final Inspection by: ..... _ ... <br /> .............................................. Date <br /> . <br /> IIi 13 2,� 1-6t3 rr. 5M .-�. ..��_.��. ........... ... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT 8/711 3M <br />