Laserfiche WebLink
FOR OFFICE Df:r fi APPLICATION FOR SANITATION PERMIT <br /> ' Permit No: _M._-01- <br /> "" (Complete in Triplicate)..:. -- ----."...... t <br /> Date Issued 6-��7-- <br /> -------- - -----------......-.--- ---- - - <br /> n " This Permit Expires 1 Year From Dale issued ` a <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 in complianceuLocal Iit/h Count ;Ordinance No. 549,and existing Rules 0V Regulations: <br /> JOB ADDRESS/LOCATION _ `T. =, ---N�-f"......� - H �r}..._.CENSUS TRACT ................--------- <br /> 7� ------Phone ................. .-------------- <br /> Owner's Name -- - MoRf-1`t-C--------- DAA, -f _T/ " - <br /> Address ----..1.�_e�1--3 -4'7-..... <br /> -- H W - - - <br /> City .:"�1 TH-R�-t'-' .................._------------------ <br /> �.. <br /> Contractor's Name MI'MAKC44-- - .Q --- L C '' -' - <br /> --license #1-..�_�� Phone .-1.37...""S7q4 <br /> Installation will serve: Resideneeleloartment House Commercial []TrailSi Court 0 <br /> Motel E]Other ............. ------- <br /> ��_ Lot Size .�.0"�i.�"!�.- .i= ..."."....... <br /> Number of living units:-"-I------ Number of bedrooms ----- Garbage Grinder .----- Private L� <br /> : <br /> ........ <br /> --- <br /> Water Supply: Public System and name ._.._...".._.------------------- <br /> Clay�t'] Peat� Sandy Loam Cloy Loam n <br /> Character of soil to a depth of 3 feet: Sand Silt❑ <br /> Hardpan ❑ Adobe h Mai nal .. --- If yes,typ <br /> e - - - ....... <br /> i on <br /> (Piot plan, showing size of lot, location of system i Y reeion-,to <br /> tt d if public buildings, <br /> ewer9s avac. must ilable wiitthin 200 feet) reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage p' P — 2_--.---. <br /> Liquid Depth ---.� -- <br /> SEPTICTANKt ] Size...-� .�Q...X- - q P <br /> I PACKAGE TREATMENT [ ] �' <br /> Capacity "1 -�© TYPePIREFA13_ Material.eOIV_C -." No. Compartments """.._....--- .. <br /> --------$�"."..Foundation _..".. �Q .. Prop. Line ---------�-- . <br /> Distance To nearest: Well , •_ / .......... <br /> ...-'.... <br /> ach line- -.. - -- Total Length ."_�a -� - ' <br /> LEACHINGE 1 � No. of Lines;I-.-.--- - - r <br /> - - <br /> `-�-___ Length of e q <br /> D' Bo - TYP �j '�---Depth Filter Material -I-/ y - <br /> a Filter Mater+al-Ct.Q:...; ;�. <br /> -FoZnda4ion "..".""."".", . .-- -- <br /> Pro a Line <br /> { Distance to nearest: Well _-_"-""-"rs Rock Filled Yes ❑ No <br /> �. Diameter Number ._---- ------------- ----- <br /> De Th --- - <br /> 1 SEEPAGE PIT [ ] P - - ' " "' <br /> Rock Size - - <br /> ------------------- <br /> Water Table Depth -_------------------- <br /> t -- Pro Line ...................... <br /> Distance to nearest: Well ---------------i--------- i---- Foundation j------------- P' <br /> __ _ Dare . -- ---- i-- -•------------- -) <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ------------- --------� fit.:,-'"-'"" <br /> Septic Tank (Specify Requirements) .v...............:.,- ..:,_,-:.rte,--.`. ti�'t---------- ---'--'".."!."".^".."..""..".."..."........_........---------------- <br /> [ 'P............................... <br /> - --------.............. <br /> Disposal Field (Specify Requirements) - !------ _--_--_____ <br /> ------------ ..... ---- <br /> I ....................................... <br /> - - -- _ r -=-- - ........... <br /> --- <br /> ............................................ (Draw exis iir�g and required a,d�dition on reverse sit1 e <br /> I hereby certify That I have preppred this.&pplicci an and ThaT'Yhe workXwill'K done in accordance with San Joequii <br /> I County Ordinances, State Laws, and Rules and Reguk7tions of t Vie.San Joaquin L'bcal Health District. Home owner or liven <br /> sed agents signature certifies the following to any Person in such mannr <br /> "I certify that In the performance,of the-work for which this porn{It is issued, 1 shell not employ <br /> m ensation IawF of Califoi ia:' ! <br /> as to b o s *Oct to or an P ; O i <br /> .�.. finer i <br /> Signed ..--------- <br /> ' ' —R DEPARTMENT Title . " ' " <br /> ). .. .. <br /> Qfother th n own •----�-----�—t [ <br /> USE ONLY i <br /> E I DATE....."_(ri.-.l. .r..68°..... <br /> - ..... .. <br /> APPLICATION ACCEPTED BY .T' - - - " ..... <br /> : --. ...... 1".._.. .DATE-:- == "..". <br /> i -- — 1:4 L- .. — — -- -— <br /> ..".."..."...........". <br /> BUILDING-PERMtT1SSl7ED". ---- - - . _......".._..."."" _ <br /> ADDITIONAL COMMENTS ---_------------------------ --- <br /> ------- <br /> .- ate _ <br /> .- . <br /> Final Inspection by: ". o-- -- <br /> SAN JOA QUIN LOCAL HEALTH DISTRICT <br />