Laserfiche WebLink
FOR OFFICE-USE_ a. <br /> ---------------------------------------------------------- APPLICATION FOR SANITATION PERMIT . <br /> I (Complete in Triplicate) Permit No_(_:_-_� -, <br /> --------------------------------------- <br /> -----------------------------------:--------------- This Permit Expires ] Year From Date Issued Date Issued <br /> Application is`W*iee'by'Mr'��5d_e to the San Joaquin Local Health District for a permit to 'constructand install the work herein <br /> described. This application_,is <br /> made in complibrice with County Ordinance Nb.Z49 and existing Rules and Regulations: <br /> JOB ADD R ESSLLQCAT 1 -----CENSUS TRACT -------------------------- <br /> L/ <br /> Owner's Name ------ -- ----- ------ -------------- ------------ ---- ------ --------------- ---Phone-----M1 <br /> --------------------------- <br /> Address y o-57y - ------------------------------------------------------ <br /> - <br /> Contractor's NdniF`�:&VN­ar-_,------------------- ------ --------------------License # ------- ---------------- Phone ------ -----------------_--- <br /> Installation will serve: Re6iderice LJ`Apdftmenl House-0 Commercialf-ITrailer Court-:0, <br /> Motel.F-1.,Other-_-�I __PcK pLoM7 <br /> Number of living units:___._____.__ Number of bedrooms ------- ----Garbage Grinder ----—---- Lot Size -------------------------- <br /> ------------------ <br /> Water Suppjy;.,PLLbLk Sy tr and,name_�--------------- ------------- ------- -------------- --------------- <br /> Character of soil to a depth of 3 feet; Sand'[]' SiltE] Clay E:]\-Peat E] Sandy Loam E] Clay-Loam '[:] <br /> Hardpan F-1 Adobe [:] Fill mclteciiat 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 SEPTIC TANK I Size---------------------\ �j Z - <br /> ------------------, ----Y,L�quld Depth ---------------- --------- <br /> Capacity -------------------- Type --- ------------ Material------ ---------I---Ii/NonC6n) <br /> I , _partments -------------- ....... <br /> 9 , k 11 #1 A U14 <br /> Distance to nearest: Well --------------_'1_1-----------------Founclatibn ....... op. Line --------------------- <br /> LEACHING LINE No. of Lin .... f <br /> ies ------- Length of bacg fine'- i jengiii ---- <br /> T <br /> 'D' B Type Filter Material R0_<__K7__Depth­jFiItei Mated /,I ---- ------------------------------ <br /> Distance to nearest: We'll --- Foundation ..... Property Line <br /> SEEPAGE,PIC-j Depth --------------------- Diameter ---------- Number ------- Rock IF ifW <br /> yi�s VoO <br /> Water Table Depth ------------------------------ ---RockSixe --L\----/------- <br /> Distance to nearest: Weil`------------------------------------------F/undatioin ----------------- Prop.,Li4 ------ <br /> REPAIR/ADDITION$iev. Sanitation Permit# ----f-'------------------------------------- D.. --------­-------- <br /> Septic Tank (Specify Requirements) ----------------- ---------------------------------------------%�,------ ----------- <br /> ---------- ----------- <br /> / ----------- <br /> Disposal Field (Specify Requirements) --------------------------:­------------------------------------------------1- . <br /> --- ---------------- - ---- --- <br /> A. _�_---------If-------- <br /> ----------- <br /> --------------------------- ---- - ----- -- --- -- -------- ------------------------------- ------- 7�h.... ----------------- <br /> --------------------- ----- ----------------------- -------------------------- ------------------------------------------------ <br /> 1� <br /> ------------------------------------------------------------------- <br /> (Draw existin§'9nd required addition on reverse side) <br /> I hereby certify that I have'prepared this application and that the work will ne <br /> dein accordance with Son Joaquin ell <br /> County Ordinances, State Laws, and Rules and Regulations of the San JoaquinlocalHealth District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for,)Vhich this permit is issued,.1 shall not employ,riny person in such manner <br /> as to become su t to Workman's rensat' 6-1aws of Cc�llifornia." <br /> Signed ----------- Z10 ---------- Owner <br /> � a <br /> &MblBy Tit1,e. 4 - <br /> jlf oiher.than owner) <br /> FOR .DEPARYMENT USE ONLY <br /> APPLICATION ACCEPTED BY _.__7T_i_fj_-a <br /> BUILDING PERMIT ISSUED . - ------------I--------------------- ------------------------- DATE ------ <br /> -1---------------------------------- ------DATE ------------------------------------------- <br /> ADDITIONAL COMMENTS)b ------a.X------ -------------- -------------- <br /> -- <br /> U------------------- AAAR --------- ---------------- <br /> -----------!a - i- L, J-� <br /> It---p4i----------------------------------------------------",­------ -------- ---------------------------------------------------------- --------------- <br /> 0Jr-)�L E-- A4# CA . <br /> --- <br /> ----------------- -------- ---- - -- -- ----- ------------ <br /> --------------------- ------ <br /> ----------------- -- -------------- 4j <br /> F= --------/----------------------------------------- <br /> Final Ins tion by. --------- ------- --- ----- ---------Date --- - <br /> --- - <br /> .3 6 _1------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />