Laserfiche WebLink
1 r./ <br /> Ir. <br /> f10R O!'fICE USEr <br /> APPLICATION FOR SANITATION PERMIT 4 <br /> �•............................................... (t�rnplete in Triplicate) permit No. ..��«.��.1.. <br /> . ..................... <br /> . . . ... <br /> ........ . . .. This Permit Expires t Year From Data Issued Do% Issued .fit :•�7, <br /> �- Appikcetion is hereby mode to the Son Joaquin Local Health District for o permit to construct and Install On work hM'rN '• <br /> described. This oppiKntion Is mode In compliance with Cou ty Ordinance No. 549 or►d existing Rules and Requlot)t>IAa <br /> JOS AOORMAOCATION �.5+�.3 ..3� .�? . :.c.<.'...L.�►�+�-'r........................CENSUS TRACT .....................««: <br /> ownerNorrie ., ... ................ .. ............ ...............Phone .....................«............. <br /> Address /S Jam.. ' Vis.,?.. ��lf ........................... .....«..»...City . •.��y4� »...............e...�...._. <br /> r <br /> ..�s...,l�`.. '' ....................................................... <br /> Contractor's Nome <br /> M►slollatbn will serve, sWence 0*portmont House Q Commercial C]Trolie Court a <br /> Motel I1 Othor .. . ................................ <br /> Mou bw of IWbV unRu ........... Numbw of <br /> bledrooms..�------Garbage Grinder ............ Lot Site <br /> .....» ................._ <br /> Wbtes S"I" Public System and none ..ate ./3C,..c.................... ❑ <br /> Choucter of soil to a depth of 3 feet Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loans❑ dal/Loan❑ <br /> Hardpan❑ Adobe❑ Fill Mctertol .. .........If yes,type......»..».....»....... <br /> WW plan, showing size of lot, location of system M rolotiorto wells, buildings, etc. must be paced an rrmw <br /> NI)W OMALLATIONr (No :spot: tank or seepage pit permltted if public sewer is available within 200 het.) <br /> PACKAOLI TREATMENT ( ) SEPTIC TANKSize.. .. .........................»....».»... Liquid Depth ............ <br /> // ,. <br /> Capocity�f.�< 'r.-Type ..1.��/. Materiel...............»..». No. Compartments ••.�'--- I <br /> • Distance to nearest, Well ....................................Foundation ..010............. Prop. Line......_.....«» <br /> LL#43*0 LI!JE ( ) No. of Lines . ..................... Length of each line ........................... Tool Length ...........»»».».»» <br /> „4'_ t,Z .....Depth Filter Material .4n.�.....................»..»..... <br /> 'D' box ../ .. . Type Filter Maferlol ' <br /> Distance to neorost, Well ......... ....... Foundation ........................ Property Line ................»--.. <br /> SEEPAGE MT ( I Depth .. . .. ........... Diome►er ................ Number . ......................... Rock Filled Yes ❑ No <br /> WaterTable Depth ... ............................................Ruck Site ................................ <br /> c Distance to nearest, Well ........................................Foundation .................... Prop. LMtr ....... <br /> R�AfR/ADsfflON(Prev. Sanitation Permit air ............................................ Dote ...............................�.. ...........�.........».. <br /> Sepik Tank ISpeclfy Requirements) ........................................ f <br /> 0100060 rule (Specify Requirements) �'�•-��).... .. , A ........................................................ <br /> .................. ............ ..... .. ......... . ... ........................................................... ...................»......................................».................. <br /> .......................... .. ... ... .. ..(Now existing aIM required add Itlon on reverse side) <br /> ............................. <br /> .. .. ............. <br /> . ...«.... _.. »... f <br /> t Iser@bV esANy that I have prgrpred this application and that the work will bo dens In accerdawce whir S" �eslsprlw <br /> C +M QrsllrNrrcos. State Laws, aired Rules and Regulations of tun San Joaquin local Health District.Nene ewher sw Itcew j <br /> sed eye ft s4rioture cerrifles the feli',wlnpl <br /> •'i "Afy that In rho performance of the work for which this permit is Issued, 1 shell not employ any person in 0rcb st0trltsM <br /> f <br /> e» 10 Isece svblect to WeAt"on's Compensation laws e1 California." T <br /> ........... Owmer -u <br /> Signed ...�'iy� 1�• '- ._ t <br /> by . .... ..� .. Dille _ ....... ......... <br /> of other than owner) l <br /> t ' <br /> L --- R DEPARTMENT,. SE ONLY <br /> -�,r-�•' ;Ro �, �L. .adl�a . ....... DATE .'�� ..."...... ...... ... I <br /> APPLICATION ACCEPTED SV DATE <br /> BUILDING PERMIT ISSUED .......... . .. ......... <br /> t 4 ADDITIONAL COMMENT; r- <br /> t Final tnspovion by �1 .:�..+��"/�-, % �-��JC �� Dat. /G.%. .../, .••...�... <br /> -- <br /> EN 1) 2b 1-1,rl itt,v. q1 S'N JOAQUIN ior"A WAITH U15TRICT --� 8/7h 39 <br />