Laserfiche WebLink
<br /> <br />e, <br />FOR OFFICE USE: <br /> <br />1 <br />APPLICATION FOR SANITATION PERMIT <br />(Complete in Triplicate) <br />Permit No. <br /> <br /> <br />./41-7/ <br /> <br />Date Issued <br /> <br />This Permit Expires 1 Year From Dale Issued <br /> <br />Application ifUrebY'mode to the San Joaquin Local Health D)strict for a permit to construct and install the work herein <br />i <br />described. This apPlication is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br />„ <br />i <br />JOB ADDRESS/LOCATION ...11.7.3.125-1-F,' g- isj VV1( /20 <br /> <br />----.. _ _ „,..:. i <br />CENSUS TRACT 5 - $.7 "••••^ \ ,:l M••••••........,........ ..... ' , . , k <br />Owner's Name ,A11) LK 4 S --1 . Phone <br />I Address ./11.50 0--- Eig/X — 1 210 . • CitY <br />Contractor's Name Zi,.1.A1SiER...._ 1 I License # Phone <br />l• Installation will serve: 1 Residence artmentt4ousefj CommerciaLnTrailpt Court CI <br />1 ki-„Cl -tq. Motel I: '--"'Oher ' / ' ti4e.:: <br /> <br />fs i <br />Number of living units'. / v..lxluijmNizi‘eirgUbeircrtooms,..2...--,.Garbage Grinder ...5 Lot Size 1./g-Cf:(_81SEeg- <br />1 11.. <br />/ <br /> <br />- ,, .m• ...., Int`7-:-.7-1-' -` Private - <br />Water Supply: Public System and name i <br />I <br />I <br />Character of soil to a depth of 3 feet: Sand 0 /,fit 6 Clay 0 -I.Peatiglell riandy Loam Clay Loam 0 <br /> <br />1 Hardp‘D Ad:lobe 0 Fill Material NO__ If yes, type ! : <br />(Plot plan, showi i ng sze of lotilocatiofl . of system in relation to wells, buildings, etc. must be Placed on revqrse side.) <br />, <br />; -'--:-------- I ' <br />NEW INSTALLATION: (No sePtic tank or seepage 1- permitted if public sewer is available within 200 feet) <br />PACKAGE TREATMENT ( ] SEPTIC TANK TI Sizee : <br />Liqt!Jid Depth 1 i 1 <br />Capacity Type Material t : <br />N Compartments <br />Distance to nearest: Well Foundation . Prop. Line <br />LEACHING LINE [ ] No. of Lines Length of each ! line f ; Total Length <br />' <br /> <br />D' Box Type Filter aterlal Depth Filter Mat riot c* <br />Distance to nearest: Well Foundation . <br />' ..11./ Proirerty Line rt <br />SEEPAGE PIT [ ] Depth ' Diame r Number I ' Rock Filled Yes 121 No 0 <br />Water Table Depth Rock Size / <br />Distance to nearest: Well Foundation <br />REPAIRJADDITION (Priv. Sanitation Pe-rtnit,# .(S--" .;- Dote ,t <br />Septic Tank (Specify Requirements) <br /> <br />Disposal Field (Specify Requirements) ADb . ! ........ ........ ii.aftc,14, _Atisi.--- —re2 <br />EXI.6Ti Ai &.-- - :‹1-"PlaC.----. <br />-ft....1 <br />I <br /> ..„- <br />(Draw <br />-- —1 <br />existing and riefuired addition on reverse side). ' i <br />7. - <br />I hereby certify theirl have iprepared this application and that the work Will be done In accordance with San Joaquin <br /> <br />) i — 7 <br />i <br />County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <br />sed agenti signature certifieahe following: <br />N. ) <br />"I cerIifyit in the perfo c of the work for which this permit is, issued, I shall not employ any person in such manner <br />as to bec subject t m 's Compensation laws of California:" <br />Signed , OWner <br />By <br /> Title <br /> -"P• rop: Line <br />--••• <br />sft <br />(If other than owner) <br />FOR DEPARTMENT USE ONLY • ' <br />DATE t; <br />DATE-. <br />LAN/ <br />. 775 <br />* APPLICATION ACCEPTED. BY,,..._ <br />BUILDING- tPERMIT—ISSUED--nkr,1/‘ <br />ADDITIONAL COMMENTS <br />... <br />Final Inspe <br />- <br />E. H. 9, Rev. 5M , <br />- stATE <br />-. SAN JOAQUIN LOCAL HEXTRVISTRICT,„ - • <br /> Date