Laserfiche WebLink
FOR OFFICE USE APPLICATION FIX SANITATION PERMIT pp <br /> Permit No. ...7y�>�+i•- <br /> (Cemplete In Triplicate) <br /> Doh Issued .4:2Y <br /> This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin local Health District for a permit to construct and install the wok hartM <br /> described. This opplication is mode in compplliancee..with County Ordinance No. 549 and existing Rules and Regula lon% <br /> JCI ADDRESSILOCATl0 8396 S, l� ... �'�' CENSUS TRACT . .....•.....'' <br /> Phone .. <br /> Own-r'z Name �/ Q1tG4.�........................ . <br /> . .:aress . .. ............ ........... City -L�ld-4rJ................. ....T....-.G....s.....z...3....... <br /> Cortfracta's Nome !ht _.License * ...... ................ Phone ........................ <br /> Installation will serve: Residom. , use❑ Commercial ❑Troll*r Court a <br /> MotelL _ .... ................... <br /> ...... . . <br /> Number of living units: Number of bedrooms .....Garbage g Grinder . lot Site .........'........ <br /> Private❑ <br /> Water, bupplyi Public System and name . ... .. . - ...................................................... <br /> Chorocte►of soil to a depth of 3 feet SMW Q Silt❑ Clay ❑ Peat Q Sandy loom ❑ Clay loom Q <br /> Fill Material If yes,type .. ..... . ' <br /> Hardpan Q Adobe �� <br /> (Plot pion, showing size of 1,-%t, location of system in re'otion to wells, buildings, etc. must be placed on reverse side•) <br /> IM WMALLATMI N- lNo septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> Size liquid Depth .......................... <br /> PACKAGE TREATMENT ( ] SEPTIC TANK( j • •�•••••••••••' ""�' " <br /> No. Com <br /> Capacity TYPe .. 00 <br /> Distance to nearest Well <br /> ..........Foundatlort .. .. ... ............ Prop. line ...................... V <br /> Ines length of each lin* Total length ................... <br /> LEACHING LINE [ J No. of t <br /> D' flax <br /> Type Filter Material I . .Depth Filter Material . ..............................•..«." <br /> Foundation Properly line ........................ to <br /> Distance to nearest Well '""" <br /> SEEPAGE PIT ( ! Depth <br /> . Diameter Numb*- ... ......, — Rock Filled Yes ❑ No Q . <br /> Water Table Depth ... .. Rock Size.. ................. ............, Litt* ................... .p <br /> .Foundation �P .. <br /> Distance to nsarast Well • •••••••••••• """""' """' ' <br /> OPAM/ADDITfON(Prey. Sanitation Permit i .._ .._ ddDote ..•••••••••••••••••••• I • ... _ >� j <br /> _ %Wlc Tank (Specify Requirements) /dW �pQ... ..........`.. ........... ....'.. .................................... .�, <br /> Disposal field (Specify Requirements) <br /> ... .. ..................................... <br /> (Draw exisring and requi•ed aj+tion on reverse side) <br /> hereby certify +het I have prepared this opplleatien and that the work will be done In accordance with Son Joaquin <br /> II!w-eRules and Regulations of the son Jeaq-•in local Health District. Herne owner or Ilcen- <br /> y Ordinances. Sate laws, and <br /> sed agents signoture eertlfiss the fellewingr person In such manner <br /> "I certify that In the porformanee of the work for which this permll is Issued, I shall reel employ any <br /> as to becerne subject to Workman's Compensation laws of Celifernla.•' <br /> Owner <br /> Signed' <br /> Tale <br /> (jf th n owner) <br /> FOR DEPARTMENT USE ONLY <br /> 177 <br /> DATE <br /> _ <br /> 'L <br /> � � J ^ _ _ I . ....... . <br /> APPLICATION t.CCEt'TED Sy /- fes/ f/// DATE <br /> SUILDING t'EVm!T I'SUfh _.. <br /> Dote /' ?7Y <br /> SAN J�AOU,r, rr, r t 14EALS1) lCrlSTPICT <br /> it C <br />