Laserfiche WebLink
df Com'�..� � �'- .� -7 • <br /> Fd OFFICE USE: <br /> t; APPLICATION FOR SA ,,ITATION PERMIT <br /> V-171 <br /> ------ ------------------ <br /> (Complete in Triplicate) Permit No. <br /> ---------=----------------------------------------------- <br /> __ __- This Permit Expires 1 Year From Date Issued bate Issued <br /> ? ,--[ c(--TT/-) "--7.i <br /> Application s 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 incompliancewith County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCA -ION --__CENSUS TRACT ---_--_------------------ , <br /> Owner's Na a ------ ------- -------------- --------------------------Phone <br /> ------------ --------------•- <br /> Address 1 <br /> Contractor'sName = 'Q` - -----License # ------ ----------- Phone --------------------------- <br /> Installation will serve: Residence K Apartment House❑ Commercial :❑Trailer Court ,❑ , <br /> Motel ❑ Other ------------------------------------------ ` <br /> P-- <br /> Number of living units:- - Number of bedrooms ---t3_ Grinder _--1------- Lot Size ------------ <br /> WaterSupply: Public System and name ----------------------------------•----------------------------------------------------------------------------Private <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam Clay Loam M <br /> Hardpan ❑ Adobe ❑ Fill Material ------------ 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.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) . <br /> PACKAGE TREATMENT I ] SEPTIC TANK:( Size------�_c _____ _________ ______ Liquid Depth -----Q2 -- 7--- <br /> Capacity ----- Type -6 - Mat ria l- -''--- ___-- No. Compartments ----1 .-_._--..._ I <br /> Distance to near Well -- _ 4--- __------Foundation � -- Prop. Line ----t_�_c_Q------ <br /> LEACHING LINE [ ] No, of Lines -.---_�-------------- Length of each line____ -- Total Length <br /> 'D' Box ------------ Type Filter Material - +�epth Filter Material -----------4_ - `'------ <br /> Distance to nearest: Well _A6_CJ-D___ -- Foundation ----� Property Line --Z—a2_ ... <br /> SEEPAGE PIT [ ] Depth �' __ Diameter ------- ------- Number _.-__ --------_-- --- Rock Filled Yes No , <br /> Water Table Depth -----------/ ---0-.-- --------------Rock Size <br /> Distance to nearest: Well -.-- - ©----- -__-Foundation -------- rop. Line ..1- o--- -- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------I <br /> Septic Tank (Specify Requirements) ------------------- ----------------------- - --•------------------------ ---------------------------- <br /> Disposal Field (Specify Requirements) ------------------ ------------------------------------- ----------------------------------------------- <br /> (Draw existingand required ad iti n rc re >srse side) <br /> I hereby certify that I have prepared this application and th t e ork ill be done in accordance with San Joaquin <br /> County Ordinances, State Laws, andand Regulations th n onquin Local Health District. home owner or licen- l <br /> sed agents signature certifies the foll Ing: <br /> "I certify that in the performance of the work for 'ch i perm! .is ed, I shall not employ any person in such manner ' <br /> as to become subject to W rkman's C ensat-s la f CN n ' <br /> Signed --------- -I----- <br /> ----"---- ---- ------------------ Owner J <br /> By --------- ----- - ------------- ------------------------------- Title <br /> (if other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY <br /> ------------- DATE - R- "L a ---------- <br /> BUILDING PERMIT ISSUED --------------------- ii� DATE ------- <br /> ADDITIONAL COMMENTS -------------- ----------- - -------------- 46.1 <br /> ------- -------- -- - --- ------------------- <br /> ------------ -- <br /> ------- -------------------------------------------- <br /> �1�t - --- ------------- --- -------- �, , ------ <br /> -_- ----------------------------- -------- -- ---------------- - - = <br /> Final Inspection bY: ----- ------- --- -- ------ ------ ------------------------------- <br /> Date --------------- <br /> I AN JOAQUIN LOCAL HEALTH R.ISTRICT <br /> f Y <br /> E. H. 9 1-'68 Rev. 5M <br />