Laserfiche WebLink
, <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �— <br /> 'I, 3�b <br /> Permit No. -. - - <br /> ............................................... (complete in Triplicate) // <br /> Date Issued ------------- •-- <br /> ...... ............ <br /> -----•-- <br /> This Permit Expires 1 Year From Date Issued <br /> l the work herein <br /> Application is hereby mode to the <br /> compliance with Counin LocUtytO Ordinance No. 549 and existing Rules rict for a permit to construct and tand Regulations: <br /> described. This application is <br /> �1 Q ' .._ ..---.._CENSUS TRACT `---- ----••-•-•••_.__ <br /> 108 ADDRESS/LOC TION/C�.---'�--rte k--?`•)7- " <br /> .._.... --....Phone -----•---•------------------------•- <br /> . <br /> Owner's Name - -..t__ . -• _-_.... -... .....-•-••-•--••---•-•-------w....-- <br /> -�.Zi_.. _.... t! _L4 t_.. City _ <br /> may. ---••-•--- <br /> Address -•-- - _ ...__._ <br /> --------- <br /> c � f�t.�y.rLicense # -�-��5 ..--• . Phone - . <br /> Contractor's Name _..__.. - - - -- . <br /> Residence[Apartment House Commercial{]Trailer Court 0 <br /> Installation will serve: <br /> Motel ❑Other ------------------------------------------- <br /> Number of living units:--.-/-.. Number of bedrooms __.Y-•-Garbage Grinder .._.-__.__. Lot Size .__--__•---•----- •-- -•-- <br /> ..........Private Q/ <br /> Water Supply: Public System and name ... ................ Peat Sandy Loom 0 Clay Loam <br /> Character of soil to a depth of 3 feet: Sand'[] Silt❑ Cloy ❑ ❑ <br /> P ❑ Adobe [].f Fill Material --.---- ..-- If yes, type -- - --- <br /> - Yti <br /> Hardpan <br /> i 'size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> (Plot plan, showing <br /> NEW INSTALLATION: jNo septic tank or see age pit permitted if public sewer is available within 200 feet, 0 <br /> i <br /> Size. ) <br /> - ...- ----- Liquid Depth ------- ...........-.... <br /> SEPTIC TANK -1�.-�1- <br /> PACKAGE TREATMENT ( ] �� pp No. Compartments -•--- - -- <br /> �,P"^-•«°�_ .Matenat..- �-•dam-- <br /> Capacity aQ._ TYPe , <br /> Distance to Weare t: Well __._-.__---- <br /> p <br /> �� Foundation Prop. Line ..:�-11�w-------- <br /> y----------.__ Length of each line_.-- -- <br /> e _..- •�- Total Length _..1.�0................ <br /> LEACHING LINE [� No. of Lines -----•- /j ______________•-------- <br /> 'D' Box .-- ------ Type Filter Material ------,5-�?..__• .-pepth Filter Material _�-._ ......-- <br /> � Prope <br /> Line, ._.�...----• <br /> ,Sa - Foundation _.:---f:�......•--•-. P <br /> ` Distance to nearest: Well --..----•-. y Rock Filled Yes � No Q <br /> ' '3 3 Number • ---..-----• .. <br /> SEEPAGE [ Depth .-- r?-5--- - Diameter <br /> 1.0-------- Rock Size _.l jY._JC_. , <br /> Water Table Depth -_---- ---•- r o-'_.-._ Prop. Line _s..----..... • <br /> Distance to nearest: Well ...... ---­----------- <br /> AIR/ADDITION <br /> .__-.-•---- . <br /> ----:--.. Dale -----....____..--- <br /> •---- - 2 <br /> --- <br /> REPAIR/ADDITION(Prev. Sanitation Permit +- - <br /> eci Requirements) -------------- . ......................-___. <br /> Septic Tank (Specify ----•---=-•--------------•-•-------------------- <br /> Requirements) .........:..... ___-_..- <br /> Disposal Field (Specify -------------------------------------------------._-- <br /> ------•----------•--•--- = - <br /> uired addition on reverse'si 1 <br /> ' ...........................................(Draw existing and req <br /> -... - -� Italian and that the work will be dons in accordance with San Joaquin <br /> Pr ared this app <br /> � thereby certify that i have p p u;n Local Health District. Home owner or �ceM <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaq erson in such manner <br /> sed agents signature certifies the following: Perm is issued, 1 shall not employ any P <br /> "I certify that in the performance Wo kman'sfthe work for which.this Compensation lows of California." <br /> as to become subject <br /> Signed .................__- <br /> .---------..._.. owner <br /> �� 4-44" Jitle <br /> By <br /> --- ------------•(If other than owner) <br /> FOR DEPA1tTMENT USE ONLY <br /> _ DATE ...Y.'.l�'-'-Z�---...---•----.. <br /> APPLICATION ION ACCEPTED <br /> .. .• - - - <br /> _._...,__�.............._..---------------•----•---...------•• DATE .....--•--••--............ <br /> BUILDING PERMIT ISSUED ...............................................- ........ <br /> ADDITIONAL COMMENTS___- •-- --- _ ------------------• ................................................ <br /> ....---•-------••--••-......_-_..... <br /> by: _---• - 's - ---eel --•....................... <br /> - <br /> Final Inspection- SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M __� <br />