Laserfiche WebLink
FOR OFFICE USE: <br /> APPLICATION sFOR .4ANITATION PERMIT <br /> --------------- �- ------ <br /> - Permit No. <br /> ,1 al < (Complete in Triplicate) <br /> bate Issued Z`2/y�71 <br /> ----------------------------------------- --------------- This Permit Expires 1 Year'From Date Issued <br /> Application is 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,iri compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION .---------- ' �. ?/ /f------i - - -!-- -------------------------=--------- ----CENSUS TRACT -------------------------- <br /> Owner's Name ---7'� .,.i.-�- - �'�LPA Phone ' �4�_•'---- --- <br /> a i <br /> Address __ �_ �----- -------- -- - - -------- ------------------=----•--. Ci#y "l �' '�-��"�-------------------------------------------- <br /> Contractor s <br /> ------------Contractor's Name -- ------ --- • _ - ---------------------------License # - I-`7-7 Phone _ 8 /�.._ <br /> Installation will serve: Residence Apartment House❑ Commercial MTrailer Court ;❑ <br /> Motel ❑Other ----------- ------ _ <br /> Number of living units:---��____ Number of bedrooms _44'P__-__._Garbage Grinder /_ ____ Lot Size ...... <br /> Water Supply.. Public System and name -------------------------=--------'-----------------------------------------------------------------------------Private ❑ <br /> Character of soil to a depth of 3 feet! Sand'❑ Silt Clay ❑ Peat❑ Sandy Loam -❑ Cloy Loam d <br /> Hardpan ❑ AdobeX Fill Material ____________ If yes,type ----------------------------- <br /> (Plot <br /> __________________________-(Plot plan, showing size of lot, location of system in relation t 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 TANKSize__ _�J�=._la_.._!X__AQ_..............Liquid Depth .......... <br /> Capacity -___,._ Type ' Material_ __ No. Compartments ____A--- -------- W <br /> Distance too nearest: Well ___'_____tJa_~_____-_______-Foundation ____ ----- Prop. Line _______S-___._.. )JLEACHING LINE No. of Lines --------IV---------- Length of each line_.____.7s_/___.------ Total Length _______ ...!... ............ <br /> 'D' Box ----- Type Filter Materia] __ ::____Depth .Filter Material ----- -_-_-117_ ____-------___ <br /> Distance to nearest: Well --------5_47__N Foundation -°-.__._-� ,t _ Property Line ---------4............ <br /> SEEPAGE PIT Depth Diameter ------ Number -------------- 2__._______ Rock Filled Yes N No i❑ <br /> Water Table Depth ------------Rock Size ---------------i`---------------- . <br /> Distance to nearest: Well -------- ----­------------__---- Foundation _____ _.__ Prop. Line •..___.+ <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) <br /> Septic Tank (Specify Requirements) 6_________ f.- -- <br /> S ----=---••-----------------=----------------------------- ---- --------------------------- <br /> Disposal Field (Specify Requirements) ------ ---------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------------- ------- ------------------- -----------------------------------------------------_--- - --------- <br /> --- --------------------------------------------------- ----------------- -------------------------'---------------------------------------------------- ---------------------------------------- <br /> (Draw existing and required addition on reverse side) 9 <br /> I hereby certify that_[ have prepared this application and that the work will be done in accordance with Son Joaquin f <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: - 0Y <br /> E <br /> "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." ' <br /> Signed .__.__. <br /> y� - � ------- ------ ---------�----- - ---------------------------------._ Owner I <br /> BY �,/ ------------- � ----------; Title ----�e�r� � ----------------------------------------- <br /> Of <br /> -----`----- ----------------------- <br /> {!f other = <br /> ________. __� an owner g• <br /> _ FO PARTM£NT USE ONLY y <br /> APPLICATION ACCEPTED, BY ------ . ------- ------------------------------------------------------- DATE - =r = f= ------------- { <br /> BUILDING PERMIT ISSUED -_--- - ------------------------------------------------------------DATE --------------------------------- <br /> ADDITIONAL COMMWT __ �__ <br /> tX-17_7------------- l <br /> - -_- -- ------------------------------------------------- <br /> _ __ <br /> --- - - ---- <br /> Final Inspection by: ------- --= --- - - - ------l---------------P------------------------'------ ------.Date fes- <br /> N JOAQUIN LOCAL--HEALTH' DISTRICT T � <br /> E. H. 9 1-'68 R . 5M <br />