Laserfiche WebLink
�1Pt'LIGAT ION <br /> ' WR 5ANITAT[t7N PEKMiT <br /> ICem:plete in Triplicate! Permit No <br /> This Permit Expires " <br /> ..........-•---•................................. res 1 Year From Date issued � O 1 ..5.---.....--•- <br /> Application la harsh made to the San <br /> described. This appllcation`is made in compliance ce wl he County Ordinance alth District for a No. 549 and existing rmit to Rules nd tand Regull the atonssein <br /> JOB ADDRESSAOCATION ..�.Q .. -- ........... .t,. .......CENSUS TRACT <br />!j Owner's Name 'I p .......... <br /> Address ...... f.. 9. i:..... ... s...... .. ............. . ... ... . ... ............Phone <br /> 4 .r...,.r` ".: �it .._....... <br /> ....1�' .._.f ....� - <br /> ..........................1............_..City 'll <br /> ............. <br /> Contractor's Name lJlf''wu .---•-•....---_- <br /> -•--- •--------•----•............................. I se # Phone <br /> Installation will servo: ig Residence❑Apartment House[] Co 'J ]Trailer Court 0 <br /> F. Motel ❑Other................................. <br /> ........... <br /> Number of living units:...... _---- Number of bedrooms Garbage Grinder Lot Size <br /> _/J? <br /> Water Supply: Public System and name ..............................._....__.............._..-._.......------•--.....__. ..... ............. i <br /> Privalea <br /> Character ofsoil to a depth of 3 feet: Sand Silt❑ Gay 83 Peat❑ Sandy Loam Z Clay Loam Q <br /> Hardpan❑ Adobe❑ Fill Material ............ If yes type............... ............ <br /> Mot plan, showing size of lot; location of system In• relation to wells, buildings, etc, must ba placed an reverse side.! <br /> NEW INSTALLATION: lNo.�septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> a PACKAGE TREATMENT ( ]' SEPTIC TANK ] -Size__3Am.-t S'......................... Liquid Depth _--.......-.-..-.. G <br /> `Capacity ..PPd.............TypeV &-f.. Material...&71 ..... No. Compartments -:20*'.. <br /> Distance to nearest: Well ZA` <br /> • ..... . ..............Foundation .. '¢ <br /> . ................. Prop. Line . ' <br /> L€ACHING LINE No.;;of Lines ._ .._.. . Length of each.fine . <br /> .......----•• ...............1..... Total Length .. d <br /> 'D' Box .h0...... Type Filter Material .IJ ......Depth Filter MaterialJ?.............I................. <br /> ionce to nearest: Wall ...74'.............. Foundation Property Line <br /> f � � , <br /> SEEPAGE PIT Depth Diameter ................ Number ........... Rock Filled Yes 0 No 0� <br /> Water Table Depth ... ••..........................................Rock Size ................................ <br /> Distance to nearest, Well ....___.•...............................Foundation <br /> ..................... Prop. Eine ..-•................ <br /> REPAIR/ADDITION(Prey. Sanitation Permit# ......... __•........................... Date <br /> Septic Tank (Specify Requirementsl ......................................... ..................................... <br /> Disposal Field fSpecify Requirements' ..........................:--.----....... / <br /> ---•---••--•--•-•-• •• ----------- ................. ---•---- ........................,........................ <br /> [ <br /> ...............................................it..............................................................------......- ------------ ........._....------...--..........._..------....---_......_•---•- <br /> JDraw existing and required addition an reverse side) <br /> I hereby certify that I have prepared this application and that the work will be clone In accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or Ilton- <br /> sed agents signature certifies the following: <br /> "I certify-that In the performance of the work for which this permit is Issued, I shall not employ any person in such reamer r <br /> as to bec suble to o an's Compensation laws of California." <br /> i=grad / a. <br /> c,� ., -- Owner <br /> By ........................ ?,` . Jule <br /> ...................•------.._.........•-- .............................. ...................................... <br /> (if other than o nen) <br /> !i. <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY:'. . ..... DATE .....:..:............. <br /> BUILDING PERMIT ISSUED ...:'............. l <br /> ......_..:.........................:-•---.........-------�- ...-�----.._.......:_..DATES.:..."_...__....._...__....:.,.__._._..... <br /> ADDITIONAL COMMENTS ....:'.. ..-...- • ............ ..... <br /> ---- ..............---•--............................................ ..... ................................. <br /> .. ..... ...... ... -----._..._......_...._......_...__..........-- ........... . -- <br /> Final Inspection b <br /> p y: ... b,- '-.✓� . ...........................-...... ........................_._....Data . ..--. -. .: ..."......"... <br /> E14 13 2h 1.613 11ov. SAN JOAQUIN" LOCAL HEALTH DISTRICT 8/7h 3M <br />