Laserfiche WebLink
- USE <br /> a�ucarioN FOR saNlrarIoN p(�ulrr r.� <br /> FORS,f/ Permit No. ..�. ..... <br /> ..................r._......... .. � -(Co�itpiete in Triplicate) <br /> .. <br /> e, .a w....:Ddtd .c <br /> This Permit Expires.j Year From tate issued <br /> ..................................... <br /> Application is hereby mode to the San Joaquin Local Health District for a permit to construct and install lite work hereto <br /> described. This application Is made in camplionte with County Ordinance No. 549 and existing Rules and Regulations: <br /> '. <br /> tON '�. . `-:`.-.•••. .. .. . ....................CENSUS TRAGR ....................:..... <br /> JOS ADDRESS/L ::........ .: �lyQ ,�..... <br /> Owners Name: ��N�.. ... •_.. . ......... .... .�. ...................................Phone ......... <br /> ......... <br /> Address ............... . --..!...... <br /> CI ..................•-_.... ...... <br /> = Pho <br /> ense����© <br /> ' Contractor's Name,�}}.. • •...............•----.....F.............._.. ne - <br /> ...:(fit ..... .. , <br /> installation will serve: encs{ apartment Houseg Commercial oTral ter Court 0 <br /> Motel 0 Other .......................•.......... <br /> wi plumber of bedrooms <br /> ..:I_-...Garbage Grinder ............ Lot Size ...--- .. -- <br /> -- --- ---• -:� <br /> Number of living units: ...-•-•<-- <br /> Water Su Public System and name --_--- <br /> ..... <br /> p>�Ys :.__.._...... <br /> .. irate <br /> E Character of soil to.a depth a$3 feet: Sand 0 Silt Q Clay 0 Peat© Sandy Loam C] COY Loam}] <br /> ► Fill Material ........_...If yes,type <br /> Hardpan© Ad"obs ❑ ............... .. <br /> (Plot plan, showing,size.of lot, location of system'in relation to welts, buildings, etc. must be placed an reverse side.) <br /> NEW lNSTALtATIONs (No septic tank or seepage pit permitted if public sewer is available within 200 feet,} r <br /> PACKAGE TREATMENT [ ] SEPTIC TANK} ] ... .............. ............... <br /> Liquid Depth .........................� <br /> Size <br /> L�+. Mtrterial....._ o. <br /> - P <br /> NCompartments <br /> ---- ------ <br /> i: Distance to nearest: Wel! ___� --- ..Foundation . -?••.• Prop D ' <br /> Line <br /> LEACHING LINE ( ] No. of Lines . ...••. ..... Length of each line--... <br /> �.................. Total tart th <br /> ` Filter Material . <br /> `D' Box .:�---.... Type Filter Material ...Depth <br /> . .? .._----..-....... <br /> �, Distance to r+e6rest:,�WeU�................-----•-• oundat[on .......................... <br /> property <br /> . Rock Filled Ye: C7 No <br /> SEEPAGE PiT } J Depth Diameter Number ........................... <br /> Water Table Depth ---•---•------••------•----••-- <br /> ...Rock Size ....... <br /> Foundation Prap. tins ........._....... <br /> Distance to nearest: Well •'"'••••••. <br /> -----•.................... _ter._.. <br /> REpAIR/ADDMON(Prev. Sanitation Permit --•--•-- <br /> ... Date •--•------ -...... <br /> Septic Tank }Specify Requirementsl ...................:..................... _ . ..........................._ .._....._......_ <br /> ( pecify.Requirements} ... <br /> .............-.... <br /> ............... <br /> _.................. <br /> Disposal Field 5 ..................\... <br /> :.'. .............. .... -••..`.. a............... ._....__................_,__._.......... - <br /> _.......... . _ . <br /> ..... <br /> ' (Draw existing and required addition on reverse side} <br /> in I hereby certify that I have prepared this application latito�ns of the San Joaquin Lc <br /> Health Distric Hens*owner ten. <br /> County Ordinances, State Laws, and Rules and Reg <br /> sed agents signature certifies the following: to a Persin such manner <br /> ,I certify that in the performance of the work far which this permit is issued, I shat) not amp y n1► p <br /> as to becownq subject to Worliman',s Compensation laws of California." <br /> I <br /> Owner <br /> .. s . <br /> k, Signed ..... .... <br /> ........ <br /> .... <br /> ............................•-........I...... <br /> By ............................. <br /> ..................... 7itls ........................................ i <br /> (if other than owner) <br /> FOR DEPARTMENT USE ONty <br /> APPLICATION ACCEPTED BY .. ....... . �.......... <br /> .......DATE.a�" �'.7, -........ <br /> DATE .............................. <br /> ............. <br /> ,: . BUILDING PERMIT ISSUED ......................----------.-..--..........•....... ... ......----........ ... ..I....................:......... , <br /> ADDITIONAL COMMENTS _._............................ <br /> Y .................................. ......................................... ........... .... .............. : ...... . .:..... .,........................................... <br /> ........ <br /> 7 ... ::.:::: :..... <br /> .......... ..................__...........­.......­..................I...... av 7 <br /> Final Inspection b ...... ........•. ...................................... Dote ....c --J:::.. . <br /> EH 13 24 1--68 &v. '5H SAN JOAQUIN LOCAL HEALTH ICI /�,, <br />