Laserfiche WebLink
_ .. . r lal�lit1�11111Nss1d1 <br /> _ ........................................., ... Date Issued -�.:�.�........ <br /> ..... <br /> This Permit Expires i Year From Date Issued <br /> p.POICt111on !s hereby ,node to ilia San `oaquin locnl No(1111 OIslrlct for n pofmlt W Mnstrvet pnd install the work herein <br /> opp%;CotlOn 11 mgaA 1n w11h cow\11( "o 1A9 t11\l, sx\\1\t\q \Ao 11i\\\ Aoq\I,11.oi\l11 <br /> JOB ADMISSAOCATION /1. <br /> .�' <4' `: ................................ <br /> ....... ......?-.�j .....CENSUS TRACT .......................... <br /> Owner's Nom �1 c- <br /> e ...... - ...........................................I................. <br /> Address - hone ..................................... <br /> -- P <br /> �2L?... �.-... .-..-./flc� _.-.-/. - CI <br /> Y • -•--- • ----- ty - - ---- <br /> Contractor's Name - -----.-- _ - -1-1 <br /> -- Z <br /> -. . . _ /1....... . .......license # L. 'R.1.>r...-..._. Phone .............................. <br /> installation will serve: Residence ❑Apartment House C] Commercial ❑Trailer Court 0 <br /> Motel ❑Other ..------- --------- --------- <br /> Number of IiVjh,? units:....___..-_ Number of bedrooms ............Garbage Grinder ------------ Lot Size -...fir-� t�c�-r---_•-----_--_ <br /> Water Supply: Public,System and name .........-----------------------•---------------------------------------------------•-----•--•----......._-Private <br /> Character of soil to a depth of 3 feet- Sand Silt❑ Clay ❑ Peat❑ Sandy Loam [Clay Loam ❑ <br /> Hardpan (] Adobe f-] 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 IN'IALLATION: (No septic tank or -aepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAC TREATMENT <br /> NT ( ] SEPTIC TANK[ j Size_- ............................................. Liquid Depth .......................... <br /> Capacity --- ------------- Type -- -- -- ---------- Material---------- ----------- No. Compartments <br /> Distance to nearest: Well -__-- _ --_--_._.Foundation ...._.-_------------- Prop. Line ..................... <br /> LEACHIN.-,LINE [ ) No. of Lines -____.._..___. Length of each line............................ Total Length D <br /> 'D' Box ------ .._ Type Filter Material ____________________Depth Filter Material ............................................ <br /> Distance to nearest: Well ...._-. Foundation ----------------- Property line ........................ <br /> SEEPAGE PIT t <br /> j Depth ----- -------------- Diameter ------ .... Number ...................... _...- Rock Filled Yes ❑ No 0S <br /> Water Table Depth ..... .. ..................Rock Size ................................ <br /> Distance to nearest: Well ........................................Foundation .................... Prop. Line ...................... <br /> REPAIR/ADDi=1C (Prov. Sanitation Permit�# ............................................ Date -.-...-._.__-..._ <br /> ----------------) <br /> Septic Tank (SFr.ify Requirements) ............................................... <br /> Disposal Fiela specify Requirements) --f-`t -�1� :� �—� � - <br /> `> <br /> ................................ <br /> ..................................... ......._.... .... ------.....-•--•---............._......._...._................_.................•--••-. <br /> _ . ............ -- ...... ...... ... ------.......... ... -•---•......--- ----•---------• --------------•---••----•-•--............•-----......................... <br /> (Draw existing and required addition on reverse side) <br /> i hereby certify that 1 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 /> "1 certify that in the nerformanco of the work for which this permit is issued, 1 shall not employ any person in such manner <br /> as to become subject ro Workman's Compensation laws of California." <br /> Signed .... .. ................. .. - n.. Owner <br /> BY ....._ .-. ._.................�•'J�l. rj..�..r....._.. C`-C�-i u Title . �ti;.... <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ............ <br /> ......:............................................................................ DATE ... s.�`�. -,.�-�.•---••-•---- - <br /> BUILDING PERMIT ISSUED . ... _...... ......................... . --....................................DATE . .................................... <br /> ADDITIONAL COMMENTS ....... ........... ....••----•------•-----•--....------------.......... <br /> .............................................................•----.............--•- ----------- ...........-_........•--................ ......................------------................ <br /> . ..................... .................................................................................................................. ..... .. ........................................ <br /> .................. . .... ........ .............. ....... <br /> .. ................. <br /> Final Inspection by: ................ . .......... <br /> /,K'.............. ................................... . ..................... <br /> ............. . -•--- •-------................... ..... --....---- . ...........Date ................ <br /> El( 13 211 1-68 lieu. 521 SAN JOAQUIN LOCAL HEALTH DISTRICT 8/711 3M <br />