Laserfiche WebLink
FOR OFFICE USE: "II <br /> H ---e�'PI.ICATION FOR SANITATION PERMIT <br /> 4 Permit No: .7�?-3 '6-. <br /> ••--• rte.:.- , <br /> --------------- . ---------•-•...._.••-------------q (Complete in Triplicate) <br /> ........................�? ..._ Date Issued <br /> This Permit Expires I Year From Date Issued <br /> Application is hereby ma4e to the San .loaquin Local Health District for a permit to construct and install the work herein <br /> ith County Ordinance No. 549 and existing Rules and Regulations: <br /> described. This application is made in compliance w ' <br /> II 16e eyp <br /> p;��ye------------ -----•----...--------•---CESUTRAC-$•T-3-�_..-.•-.-1JOB ADDRESS/LOCATION -Ye ---- ------Phone ---- <br /> Owner's Name _ . PSBonniO.Z.._... <br /> .-. -...__ <br /> .. _.. .. <br /> t <br /> ... <br /> ........................................City <br /> Address yM.....• ....... <br /> -- Phone ....� --- ----••----.:... <br /> Contractor's Name ....]43 133°5��.._p•Z7:mb ng._.��''et' tae. ........License # ----9c�5 '----- <br /> Installation will serve: Residence X]Apartment House 0 Commercial 70Trailer Court 0 <br /> Motet Q Other.. <br /> --------------------- <br /> Number of living units:__:±��I-__-_- Number of bedrooms .___ sarbage Grinder ------------ Lot Size ... --q. <br /> ................... <br /> Private ( . <br /> Water Supply: Public System and name ...................----------------•---- - --- <br /> Character Peat Sandy Loam Q Clay Loam <br /> Character of soil to a depth of 3 feet: Sand� Silt❑ Clay ❑ ❑ <br /> I� Hardpan Q Adobe-E] Fill Material ............ If yes,type <br /> NO <br /> (Plot plan, showing size lof lot Location of system in relation to wells, buildings, etc. must..be. placed on reverse side.) X <br /> NEW INSTALLATION: (No•septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> Slze' - Liquld Depth --------•--... <br /> PACKAGE TREATMENT .[ ],� SEPTIC TANK,[ ]"� t .,� <br /> ----•:--_------------•------- <br /> 'r �-�-•--• . Material--------- ------ No., Compartments --- ---------- <br /> i . Capacity -------•--------- ;.Type T.._.... -; r <br /> �--- <br /> D'#ance to nearest: Well -.----- :--..--••--••••-•.•..Founda_tion .- ---•-• -:-•••.. Prop. line ------------- ------•- <br /> I�. Total Length <br /> t No. of Lines Length,of each line------- ---_ -------- g <br /> LEACHING LINE: [ ] <br /> '0' Box ............ Type Filter Material:.........4.........Depth Filter Material' <br /> .................• _ <br /> �!F Foundation ... ....... <br /> to nearest: Well ___...______..-._-_--- <br /> ±+ ._. Rock Filled Yes Q No <br /> SEEPAGE PIT ( ] Depth Diameter ..........------ Number .--- :-`-•---•--- <br /> ] Water Table Depth 11 1----••...Rock Sizet.... ...--••------•-•-------•-•- <br /> ------------------- <br /> Distance to nearest: Well --------------------------••••4••----•-•Foundation ----- •---I••• Prop. Line .--.--.--.-........... <br /> REPAIR/ADDITION(Prev.Sanitation Permit# ------------------------------•••.... <br /> L-----Date _"=.......... " ---------1 <br /> , <br /> Septic Tank {Specify Riquirementsl ----=-----------• -- --------_----- ---------- ._...,.... ............ <br /> :I ZQO-Z�n_ ...• 1 W <br /> Disposal Field (Specify Requirements) _____________ _______-- ---��-'--•--idB•_-leaGl?a,ng...d>kat2.. .R-- <br /> ....----•-..... ........ <br /> ... <br /> = -------- ----- <br /> S j <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I hl�ve 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 <br /> sed agents signature certifies the following: P erson in such manner <br /> "1-certify that in-the--perfbrma o t work for which'this ermit•is issued, 1 shall not employ any p i t <br /> as to become subject to Worl an's Co ens n of Iifor ia." <br /> Signed p UIST''Pry... ..-I�ITG = ' ------ . ---- . <br /> By --------------------------------------------- <br /> itle .-----� _nag_ l_ - <br /> (if other than own <br /> FOR DEP Att ENT USE.ONLY <br /> APPLICATION ACCEPTED BY _-----------------_-- -------==-----_---------- - <br /> ...... <br /> ,�.� �1,... DATE ...__ 6-7u-•-............. <br /> BUILDING PERMIT ISSUED ------------------------------------ _._----•---- <br /> -------DATE <br /> ADDITIONALCOMMENTS --.---..--_---- --•--------•-------=--•----••--•-----•---•----------------------•-----'-----•----------•-- -- <br /> .------------------------ ------. ......------•----._......---.._..........-•---•.--------•- •-----... <br /> .---•-•-----...• = -•---------•---•••-----•---------------- <br /> ±c 4�1 a l <br /> ----------------•- :-=-..._.... - Date .... __.... ------ <br /> Final Inspection by: -------i ----- ------------ --- <br /> SAN JOAQUIN LOCAL HEALTH Dl RICT <br /> E. H. 9 1-'68 Rev. 5M <br />