Laserfiche WebLink
FOR OFFICE USE: <br /> p; APPLICATION ICOR 5AWATION PERMIT <br /> .............. ............ <br /> lcompleto In Triplicate) Permit Na ...._T......i-----• <br /> .........:......................................... . This Permit Expires t Year From Date Issued <br /> Date Issued <br /> Appiication is hereby made to the Sdn Joaquin Local Health District for a permit to construct and instal) the work herein <br /> described. This application Is made in compliance with County Qrdinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION <br /> . k' ..... <br /> ........... ....CENSUS TR.A8CT <br /> Owner's Name <br /> .. <br /> Z 3/b. . on <br /> Address -...... . ..�2/...�3._..//�c,�-7� ........................................Ci <br /> (� ty .mss/-.G:.C Vic: ............................. - <br /> Con'tractor's Name .............:........License # ... Phone _----- <br /> .---------- <br /> Installation will serve: Residence Apartment`House❑ Commercial❑Trailer Court 0 <br /> Motel ❑Other-•-••••.. .:...:............................ <br /> Number of living units_____________ Number of bedrooms -...L <br /> .:L.._.Garbage Grinder ............. Lot Size <br /> Water Supply: Public System and name ........................................................r..:-------. -- <br /> ..Private []. <br /> Character of soil to a depth of 3 feet; Sand j] Silt❑ Clay d Peat❑ Sandy Loom ❑ Clay Loam❑ <br /> .Hardpan 0 Adobe 0 Fill Materlal ............ If yes,type....a....... <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 pe <br /> ,LmNed if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT t ]-4SEPTIC TANK Yx poo ze <br /> ...... .....:.:................................. Llquid,Depth ..--•-••--._......_.-- <br /> ?( Capacity _. Type - :.... Material Na. Compartments ------------- -------- <br /> Distance <br /> -Distance to nearest: Well ............... --------------.....--- Prop. Line ---. ..--•--•-----• N <br /> LEACHING LINE [ ] No.. of Lines ........................ Length of each line.-........................ Total Length ..............:------------- <br /> 7-00 <br /> ---•-----•-•Zdd PL . ��L'P' Bax ._.._.-- TYPe Filter Material Depth f=ilter Materia! ...............----•.-•.' '.. ----....___. <br /> Distance to nearest: Well ..:..................... Foundation ._.........----------... Property Line •---- -- --.....__.� <br /> De �� _ Diameter ���� �_� <br /> Depth .._..-.-•-------- --• ---------------- Number -=-------..:.............__. <br /> Rock Filled Yes No <br /> K.,V*Z Q�p it' Water Table Depth .... ...•......_....._..Rock Size ................................ <br /> l <br /> A� � r <br /> X`� Distance tolnearest. Well .... ..................................Foundation ------.............. Prop. Line ..._....._.----.4 <br /> REPAIR/ADD1T ON(Prev. Sanitation Permit� _,Date ' <br /> 4. V <br /> Septic Tank (Specify Requireme ts)k---•-- -..... ......:....:......:. ......�. . . ... .� <br /> C. <br /> Disposal Field lSpeci#y Requirements) _._. _ ------�--.:_-.--_- ..... ---,-_ -•_ _. <br /> �. <br /> ----f:--------�l.-• --'"rip zP. l a. ...1_s:''X._.._ . �-�- <br /> 1 -. <br /> "ilDraxistin and re u�red addition on raver <br /> # r se side <br /> I hereby certify that 1 have prepared this application antithat'ehe4work will be done In accordance With•Son Joaquin <br /> County Ordinances, State laws, and Rules and Re ulations of the San .faaquin-Falai Heath:District. Hattie owner.or.licen- <br /> sed agents signature certifies the follow ,J V _ <br /> "I certify that in the performance of the wor for which this permit is issued, l shall not employ any person In such manner <br /> as to ker.0me su ct t W km £s anon laws of California." f <br /> Signed _._ . tri Gv --------------------------- --------- Owner <br /> BY ....... ......... <br /> (if other than q�vner), Title ................... <br /> DEPARTME USE ONLY <br /> APPLICATION ACCEPTED BY --le . - ..•• DATE <br /> BUILDING PERMIT ISSUED _........... <br /> --'. --- ----------------------------- �1.. .....y�. -� DATE .-----------.._.._..._._ <br /> ADDITIONAL COMMENTS .t -.�57/N�__•.�I¢�} ....! __ ,3-� �+ <br /> X ...... 9i!!'.�- S' 'Ti ........................ <br /> �� ' x'`1 7 ✓� r-o&•cs,�/ <br /> ------•------------------------- -----------4.4 01 s.. _ _seal..- ra�/�_c .....�'. x .... "�` /fo .._�.�...- i .,-r.q-z r.�t...r------- <br /> Final <br /> /. <br /> F _________________________ _ _____ _ �_-_____._._.____.______.. . may._ <br /> Final Inspection by: _ _ ---- ... 7/lrt G __..Dote .---.r_...1..._.... <br /> EH <br /> 13 2h 1-68Rev. 5mSAN JO QLIIN LOCAL HEALTH DISTRICT 8/7h 3M <br /> t <br />