Laserfiche WebLink
APPLICATION ICOR SANITATION PERMIT <br /> {Complete in Triplicate) Permit No. ..7s..:: ...:. <br /> - r <br /> .............I..........._. This Permit Expires 1 Year From Date Issued Date Issued <br /> Application is hereby made to the Son .Joaquin Local Health District for a permit to construct and Install the work herein i <br /> describer!. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCA l0 � .........................................CENSUS TRACT ..... <br /> 1..n. <br /> Owner's Name .. . f✓...- '.11.4 ...................I............... Phone . <br /> Address ...._ ... Ci <br /> i <br /> Contractor's Name .--`=f- 4- ---------------y-- -------- ... .. ----------------License Phone <br /> Installation will serve: Residence Apartment House 0 Commercial OTrailer Court ❑ <br /> Motei ❑Other............................................ ' <br /> Number of living units:..._-_.- Number of bedrooms -----eF--Gorbage Grinder ............ Lot Size ............................................. <br /> Water Supply: Public System and name ..............-.......•............................... ---------- ---....,,.................................Private <br /> Character of soil to a depth of 3 feet: Sand'. Silt[] Clay ❑ Peal❑ Sandy Loam o Clay Loam ❑ <br /> Hardpan❑ Adobe 0 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 ublic sewer is available within 200 feet,) <br /> i <br /> PACKAGE TREATMENT [ ] SEPTIC TANK f I Size... ......................... ................ Liquid Depth ....................... <br /> i <br /> Capacity -----------------_- Type .---------------- _ Material------. -__.-- No. Compartments <br /> Distance. to nearest: Well ....................F ndation ...................... Prop. Line ...................... <br /> LEACHING LINE [ j No. of Lines ---_--------- ------ Leng of each lin ---------- .................. Total Length ............................ <br /> 'D' Box ............ Type Filter Ma rial .............. .....Depth .Filter Material <br /> Distance to nearest: Well .... ................... F ndation ---•------.._.-......... Property Line ........................% f <br /> SEEPAGE PIT [ ) Depth .-•--------------- Dia ter _._ ------ Number ._.......................... Rock Filled Yes ❑ No Cl to <br /> Water Table Depth Rock Size °Q <br /> Distance to nearest: ell ................... ..........••----....Foundation ._.......:. ........ Prop. line ...................... Z <br /> REI'A!R/ADDITION IPrev. Sanitation Permit Date ._..._..--- •...............:.... ) <br /> Septic Tank (Specify Requirements) ... <br /> Disposa Fi i (Specify Rec a ants) ....._/ ............. ---------------------- . --------._._...._....------. ' <br /> � _ <br /> ---------- .. ... ..�_ � � yl <br /> -------------------------- --•-•---------------------- --------------------------------------------------.......................................................................................... <br /> .. <br /> (Draw existing and required addition on reverse side) .�71 <br /> I hereby certify that 1 have prepared this application and that the work will be done in accordance with Son .Joaquin.S <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health;District. Home owner or licen- <br /> sed agents signature certifies the following: t <br /> "I certify that in the performance of the work for which this permit is Issued, t shall not employ any person In such manner <br /> as to become subject to Work an's Compensation laws of California." <br /> Afe <br /> Signed - --------_----•-••---- ----- ----- Owner <br /> By --------- ........... ........• Jitle --------- • -- <br /> (#f other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -_. -------.. DATE .;. -.. �� ............. <br /> BUILDING PERMIT ISSUED ..-_--- -•- -----------------------------------._DATE ........................................... <br /> ADDITIONALCOMMENTS --------------------------------------------------11-1......... - .......,....--------- <br /> ------------------------ <br /> ------------- ------------- ----- ---------------------------..._..---------------------................-------------------------- ........ ..__._...--• -- ---•----._.._.... <br /> --•------------ ------------------ ---- - - •--•- <br /> FinalInspection by: ...... •---- - ----------- ------------------------ ............-..--•-------...._..- -....----- --- .......Date _... . '. .....-- •�---.. ......... <br /> M 13 24 1-68 � 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 874 3M <br />