Laserfiche WebLink
rQK OFFICE USE: <br /> I .APPLICATIO <br /> N FOR $ANITATION PERMIT <br /> ........... :.... - .. ", .. 1Complete,in Triplicate} <br /> _.........:. �:.._.......: Permit <br /> .. <br /> This Permit Expires 1 Year prom Date es�a <br /> Date Issued .1`........ .. <br /> Application Is hereby made to the San J <br /> described. This applicoaquin loco! Health District fora permit toyconstruct and install the work herein <br /> + <br /> I ation is mcide�in compliance with County Ordina ce Na. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATI4N ... ..•��r -�► <br /> 1 Owners Name ._._.._.... _ ..... <br /> --.... <br /> Address --- -•---•... !tel--• ........ -Phone <br /> . <br /> r <br /> Contractor's Name <br /> Ize .. `: <br /> Installation will serve: L€�^ S .._ �, �-� <br /> sidenceApartment Houset] Ca:nmercial„otrailer Court <br /> Motel X <br /> Other--.-----::�°�. <br /> Number of livingE <br /> units:..-1.�o_ Number of bedrooms ' . l` r <br /> --.-.Garbage Grinder <br /> Water Supply: PublicAS stem a - t ,Siz . <br /> Y and name e <br /> Lot <br /> .. - ... .:....: <br /> Character of soil to a i.- ...PrivptoX <br /> depth of 3 feet: Sand0 Slit t3 Clay t <br /> .;. Peau'[} S�cirEi#'l opm..fl <br /> ardpan=[I�Adobe I} Y Ctay�i oa <br /> �.. � W i��. i_Materlal,. <br /> Plot plan, sho vI �� .. � . .. ..-----•-•-• , <br /> • -•;i 1 Yes aype... � <br /> ri•g -v,;� .of lot, location of system ,in'trelat€on to wells, <br /> NEW iNSTALulldino <br /> LA 1ON {(ya septic tank or seepage pit i ii m d If public ae or s/ . must be plated on reverse side.) <br /> PACKAGE�TR,EATMENT ] Size............. ailabl w€thin 2E?0 feet,} <br /> �_. 1. <br />.. [ SEPTIC TANK t <br /> Capacity liquid Depth <br /> C ................ . <br /> fiy� ------. ......•----- Material---�..--- No�Con1p <br /> Distance to nearest: Well cirtments ._--.....__ <br /> �._--=_• ....�-.::.. •---•-•-Foundation k <br /> LEACHING LINE ........, r Line .. <br /> P No. .. Len Length of f. - <br /> t i of lines .._._................. p L <br /> g eaeh line...._. ..-- I. ... --- Total JLP�ngth <br /> 'D' Box .. ----- T <br /> . } t ype Filter Material ...---,--_ . .Depth Fitter Mate al 4 <br /> Distance to nearest: Weill..... - Foundation ._..---••----------•--•------ <br /> 'ID <br /> _....._:... l'ro i <br /> SEEPAGE PIT � pierty line ........... f <br /> t)i eter ------------­- Number ..............t.--•• . Rock Filled Yes Q Nci >D�+ <br /> Water Tablet Depth ----- <br /> - •-------- . <br /> Rotk Size <br /> Distance to nearest: Well t <br /> _ <br /> k � <br /> . ........ <br /> ._Foun-dcti-o-_n <br /> -"-"".`� <br /> ••". <br /> } <br /> Prop. Linete ............ <br /> ..........REPAIR/ADDITkION(Prev.Prev. Sanitation Permits . ------•----•------- DateSe tic Tanks(Specify Requirements). ...... <br /> Dispos � .1pecYts Requirements) _-----a ..° 'C <br /> �t {� <br /> --•- .._. . _... <br /> I -q� � <br /> --------- <br /> (Draw existing and requiredaddition on reverse aiside) "" <br /> I hereby certify thal�l. have,prepared this application and that the work will be#done�inTaccordance with San Joaquin” <br /> County Ordinances, Slate Laws. and Role*,and Regulations of the San Jaaquirt total }lealthjDlslrkt. Home owner or licen- <br /> sed agents signature certifies the i'ollov ng; <br /> "1 certify that in the perFormanc76 the work for which this permit is issued, <br /> as to become subject to Workman's Compensationi iaw.s,ofvCalifornia." !'shcifi not employ any person in such manner <br /> Signed ._.. <br /> - -•--•---- <br /> � <br /> By ......._ wner <br /> (If o than owner) <br /> •-•--•................ title .... <br /> —= FOR DEPARTMENT USE ,ONLY <br /> APPLICATION ACCEPTED BY._._---... _ 1( It <br /> BUILDING PERMIT ISSUED ............. �. �_------ i <br /> ._..... DATIti <br /> ADDITIONAL COMMENTS <br /> ----•--• ...DATE <br /> �iY tz. <br /> ....-- <br /> ...................... ,n._ .. - ----• --•--.--_----•---• -----........_......................... <br /> .._..._....__. <br /> • ,.ter- � ,.�,�,,,�,,,,._, <br /> --------- <br /> Final Inspection -----. ---- ----------- ----••--- ......... . . <br /> EH 13 2J� 1-�6fi Ilev. 5�I .................... .. <br /> . .__...Date - ----'�._-��..- ---,� . <br /> SAN JO QUfN LO 'AL HEALTH DISTRICT f, -------- <br /> 8/7h 3M <br />