Laserfiche WebLink
FOR OFFICE USE: v-PLICATION FOR SANITATION PER <br /> L <br /> Permit No. <br /> (Complete in Triplicate) <br /> - . ......... <br /> Date Issued <br /> This Permit Expires I Year From Date Issued <br /> 7G /1 t/u r <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 compliance with'}County Ordinance NO. 5496d existing Rules and Regulations: <br /> )JCr JOB ADDRESS/LOCATION ..... Q. ..C�.._....tiL. - . TQI/� �-.rl/ f �NSUS TRACT .................'....... <br /> - <br /> ' 3. ... ./ <br /> Owner's NanW) ......................--------"---------------- ...Phone �..�.'.......—.... � .1 <br /> Address _.- - ..-----.............................. ............................. City ........................................................ - .................... <br /> Contractor's Name -..�� ...JP CCY-SC ......................................... �67 License # .9L. PhoneJ5 '.=2 1i6 <br /> Installation will serve: Residence N Apartment House Commercial ❑Trailer Court t] <br /> Y Motel ❑Other .------...._. ------------------------- <br /> Number of living units: D_ Number of bedrooms -.3-----Garbage Grinder .,)?e.cL5 Lot Size ............................................ <br /> Water Supply: Public System and name .---...................----.....------......------------........--.......... ......-------.....Private, \ <br /> Character of soil to a depth of 3 feet: Sand Silt F1 Clay ❑ Peat❑ Sandy Loam C] Clay Loam ❑ <br /> Hardpan,❑` Adobe ❑ Fill Material ............ If yes, type ............................ <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 permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK t ] p Size------------------------------------------------ <br /> Liquid Depth --........--........ . <br /> Capacity/.0'd. ?.... Type />t7-�tr1:- Material .P.- 1)Q-t1 No. Compartments --)--.------ ...-S <br /> le / 1 <br /> Distance to nearest: Well ..I.-?Q....... Foundation lo.............. Prop. Line .----.U...--....... <br /> LEACHING LINE [ ] No. of Lines ....... ............ Length of Bach,line..-_.t�.a'...-_.-....... Total Length r t..�z............. <br /> 'D' Box ..._/.... Type Filter Material ... .-z........ Depth Filter Material .._.... .. <br /> Distance to nearest: Well --1 5.----- ..... Foundation ..�7...�........... Property Line <br /> [ ] Depth -_. .............. Diameter ................ Number .._ ....................... Rock Filled Yes ❑ No ❑ <br /> Water Table Depth -----------............... .....................Rock Size ..... ..........---... ------ <br /> Distance to nearest: Well ........................................Foundation .................... Prop. Line .....................- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# --- ----------------I—---.--------*....... Date .................................-) <br /> SepticTank (Specify Requirements) .......--.....................................-------•--...-.........------.....:_..---•----•-----------.....------------------------ <br /> Disposal Field (Specify Requirements) <br /> ` ----------- <br /> -------------------------------- ............._.............................._.................... ....­... .............I..".....I............. <br /> .-................----------'-------'--------....-----------•------------•-----.......`.---------------------------...----....-----.I........................ <br /> ........... ...... ................................. ........................ <br /> (Draw existing and required addition on reverse side) <br /> ._ 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <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: <br /> "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed 'o.....__._._...............-'-- ----.--. ---..------------ ................ Owner <br /> By --.. . �.�. LG9^ ........ - - ...-.._... ... Title ........_................ .. .----....------._..._.._......-.. <br /> (If other than owner) <br /> R DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY .... - ............... - -..................- -•----........ DATE ..L.2_. ._L .. ----'---- <br /> BUILDING PERMIT ISSUEDDATE <br /> a. G �It F ". --- . .- <br /> A4.ADDITIONAL COMMENTO.;= e - " . .. - <br /> -------- ... ...*---------- --- -------------------------------------------------------- ............- <br /> y <br /> R'.S . ... ....... _ <br /> ------------------------ ..-... <br /> _ <br /> ..... . .... -.. .. ------ --...------ :°sF`....,..... a.. ..... . <br /> - - .... '--- .......... ....Inspect --- - -- --. ..............- - ......-..._..-.............Date .. . .. <br /> Final ion by: .. r e..:: - - ..._..................... - ..� ...- .-.... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT PLATE 11, Page 4 of 16 <br />