Laserfiche WebLink
FOR OFFICE i15E APPLICATION ICOR SANITATION PERMIT <br /> .................` ................................ <br /> (Complete In Triplicate) x Permit No. � .����`3 <br /> . ..........,; :=...................................... <br /> .... This Permit Expires I Year from Date Issued <br /> T —Date lssuec!42 .... <br /> Application Is hereby made to the San Joaquin Local Health District',for 'b,,peimitxto construct and-install the work heroin <br /> described. This application is made in complicijce wth County Ordinna}nce-No.-549"arid-existing-Ruloi.and.Reguiationso <br /> .LOB ADDRESS/LOCATI0N7/. ��� .�� �� ..... '� ../�-� .>........................... CENSUS^TRACT .... ............. <br /> Owner': Name- .. f t ......, ............ ............... Phone fT�d" :.. <br /> r <br /> Address. . - ......................................City . � ...... ..�. ... <br /> .... .. .... .. <br /> Contractor's Name __460_5 <br /> . - ; License # . ��- Phono.�.92A <br /> Installation will serve: esidencs partment House 0 Commercial flTrailer Court w0 ' E <br /> 3 � Motel[)Other-------------_-------- ---------- ..... ; <br /> Number of living units:_..---.-...'---,.Number of bedrooms ----•-Garbage Grinder --..-- ... Lot Size ..:......................................... <br /> Water Supply: Public Syaterin anld name ...............................-__-----------------.__...................................................Private ❑ <br /> Character of soil to a depth o 4ot: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ t` <br /> ' � f Hardpan❑ Adobe❑ Fill M6terlal ............If yes,type ... <br /> uunu���i � � ar�a�rrorn�����lunm n�nninwii--�—yn <br /> (Plot plan, showing size of to,' location of system in naldtion to, <br /> wells, buildings, etc. must be placed on reverse side.! <br /> NEW INSTALLATION: (No septic tank:or seepage pit::permitted If public server.is available within 204 feet,) <br /> PACKAGE TREATMENT {_]Z -SEPTIC TANK f J Size.. .... :.. ........:.....:...... Liquid Depth ............... <br /> Capacity+&'. '. ape:`- �:a: aterial...................... No. Compartments -.� ........... <br /> � r <br /> ' Distance to nearest- Well'.' <br /> -----------------------------------Foundation ...................... Prop. Line . <br /> LEACHING LINE [ D No".lof Lines ..................... ! Length of each lI e.___......••_•••._•_•:__•._. Total Length ....................�.. <br /> 01 f <br /> 'D' Box ._/...... Type,�l~.ilterwMaterial . .. . ..Depth Filter Material 2.10,................................. <br /> . * - undation ••_••• Property Line ..:....................Distance to neeshN "" ....---•-....- -. ......... <br /> SEEPAGE PIT [ ] Depth ...-�............... Diameter ....a........... Number ........... Rock Filled Yes ❑ No <br /> li l ' <br /> F. Water Table. Depth '`_--.F----------- ........Rock Size ---•--•......................... <br /> � <br /> :t..' <br /> -- -- Qistan7�"te_nearest: Well ` ...Foundation Prop. Line ............ ... <br /> REPAIR/ADDITION(Prov. Seriitation Permit#- ...... .......... .Z:I........ Date .........••__.__-- I <br /> Septic Tank {Specify Requirements) .........." .... ............. -- 'i1 .......... . ...., ... _.._ .----........._......._............... <br /> Disposal Field (Specify) `Requirements)',..Y _ LrJt�. ..,:..,.� - �'.. ........ <br /> 4 iYF <br /> ......................................................................:.............................�..:`i..........................................................................................-.... <br /> ............................. i . . ...._._.I.......-_...__... I——__.....__........_.___.....................�...... <br /> (Draw existing and requlred addition on reverse side) P <br /> I hereby certify that I hoW prepared this s(pplicalloh.and,'thof the work will be done In accordance with San Joaquin <br /> County Ordinances, State tL ws, and Rules and Regulations of the San Joaquin Local Health District. Hayne owner or Ilton• <br /> sed agents signature certifies.the following:1 <br /> "I certify that In the performance of the work for vvhlch thls permit is Issued, I shall not employ any person In such manner . <br /> { as to becom ub ect to Workman's-Compid6sation laws of California" <br /> Signed .....C�-f. _ ...... <br /> ............. .......... <br /> Title ..:............ <br /> (if other than owner) <br /> R DPARE SE ONLY <br /> APPLICATION ACCEPTED &Y .. ...- DATE.... . •r' -..-- <br /> BUILDING PERMIT ISSUED .................... ...... - ©ATE <br /> ................... ......................................... . <br /> ADDITIONACCOMMENTS .................................................................._. ---------........................................... ..........I.......... ....... <br /> :...;................... _.._ .....-- ..... ... •------•--........ .: ........................... r '............. <br /> Final Inspection by: .................................................Date .- ...................r ..... <br /> EH 13 2h 1-68 Rev. SAN JOAQUIN LOCAL. HEALTH DISTRICT 8/7h 3M <br />