Laserfiche WebLink
FOR OFFICE" USE- APPLICATION FOR SANITA rON PERMIT <br /> Permit No. <br /> F...I . ....... M1. ' .(Complete.in Triplicate) _ <br /> Date issued S <br /> $ This Permit Expires 1 Year From Date Issued <br /> I� <br /> Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance N 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION :.... _w_(/.. ..T�s ,f,/ ... ..........� /... ............... CENSUS TRACT ... . <br /> ....... <br /> ,q 36 --------- <br /> Owner's Name•.: ��°fir`�-..._..�1 .......................... ...................................Phone ...... ._ <br /> ,. / ...:City <br />} <br /> 'Address: <br /> . .................%. <br /> Contractor's Name _' .:...... . .R - ------.License <br /> I <br /> Installation will set Residence©Apartment House{] Commercial❑fraller Court ❑ <br /> t <br /> Motel []Other ••........... <br /> ' Number!-of living units:......-•__-- 'Number of bedrooms Garbage Grinder Lot Size ---- ----- ............................. <br /> ! <br /> Water S pply.. Public System and name ................. ....Prhrate ©- <br /> Character of soil to a depth of 3 feat: Sand❑ Silt❑.. .Clay ❑ Peat❑ Sandy Loam❑ `Clay Loam ❑ <br /> ' Hardpan 0 Adobe 0Fill Materia! ............if yes,type <br /> ............... ........... <br /> t .I <br /> (Plot plan, showing size of 'lot, location of system in relation to wells, buildings, etc. must be, plated an revarse side.) <br /> rte- III <br /> I , NEW INSTA"TION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT I ] SEPTIC TANK{ ] Size........ �...................... Liquid Depth 1.�..d----J-•- <br /> -•--•----- <br /> Capacity -._ ------ Type - '' ' ---- Material.. '^` ---.:•.. No. Compartments •• ...--.-- <br /> Foundation �d .. Prop. Line . <br /> :I- <br /> : DistancE to nearest:,Wel.,_....� ..................... . .. I2r-. .. <br /> LEACHING LINE [ } No. of Lines 3--.-•-••.---. . Length of each line-----Z..6r.............. Total Length ..__. ------...._..:...__.. <br /> r D' Box ............ Type Filter. Material ....................Depth Fitter Material .---.............I...........••• .. <br /> -� <br /> s Distance #o nearest: Well /16V......... Foundation ....L-.4.19!........ Property Line ...2Q ......... <br /> s # r-y ` 3 Number ....._._ Rock Filled Yes ❑ No ❑ <br /> SEEPAGE PIT . ( ( <br /> Depth ::............:. Diameter ._.. ......--••-- <br /> - i : <br /> Water Table Depth ..•-•:.._.......................................Rock Size •••...••• <br /> Distance to'nearest::Well <br /> ....Foundation --•-: Prop. line <br /> REPAIR (Prey. Sanitation Permit Date ...._:_............................} <br /> SeptOTonk (Specify Requirements) - +, - — -- -- - -- _ .. -....------......................... <br /> ' Disposal Field (Specify Re uirehients ........... . ..................... <br /> ......................................................................................................I................... . -�� ^�.-... _-.- .......................................... <br /> .cz -....� .-.--r-. - . . .. .-.•-......•- . if <br /> I' -4 -------------------------------------------........................................................_....-_........................_.... - <br /> (Draw existing dnd required addition on reverse side) <br /> I herebi certify that i have prepared this applicaitioti and that the work will be done in accordance with San Joaquin <br /> f County Ordinances, State Laws, and'Rules and Regulations of the San Joaquln :I.ecal Health:Distdct. Home owner or lice* <br /> sed agents signature certifies the following: « <br /> "I certify that in the perFormance of the work for which this permit is issuatl, l shalt_ nal employ any person in such manner <br /> Owner as to b®ca ub ect to Wor n m ensation laws of California! <br /> Signed _��_-.._ <br /> P <br /> ---- ---• -- •- •. .. . ................. caner <br /> !I <br /> Title .r_..___ ---... <br /> g' -•-•-- <br /> er than owner) <br /> - R DEPARTMENT USE-ONLY . .�` <br /> APPLICATION, ACCEPTED BY _ ..�- DATE---- _..._. ... _.........__ <br /> -- ------- <br /> BUILDING Pi:RMIT ISSUED __.--_= ---------•------.--------------. ....... DATE ...............- ------- -------------- <br /> ADDITiQNALCOMMENTS ------------ .. ................ ............................................................................................................. <br /> -------------- ....................................................•-......................... <br /> --- <br /> !( •--•------------•-•....---.._.. •• ----•................ ---•----- ----•-. ------------------------------ ---- --•...__....--------------- <br /> ----------- (--------------------- f�,. � -------- •--•--- ----------- --- ---:-.... ------ <br /> ... ... <br /> - <br /> Date .. .............. <br /> . Final Inspection by: �l/,�.__. ..... .-....... __..__.------------------.-._._.._._...-.__... -•---- . ._ <br /> Eli 13 Q2h 1--68 Rev. 5Ai SAN JOAQUIN L CAI. HEALTH DISTRICT 74 3M <br />