Laserfiche WebLink
' 3 <br /> FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ................................. Permit No. 5. � <br /> (Complete in Triplicate) -'•-•--`...... <br /> 5 <br /> ...... ................................ ... . ........ This Permit Expires 1 Year From Date Issued Date Issued _ :72:25 <br /> Application is hereby made to the San Joaquin'L•ocal'Health b7strict'for a permit to construct and instal{ thework herein <br /> described, This application is made in compiiance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION J.f .gf ......z� �"�(,� i� ................... ....................CENSUS TRACT ........... <br /> Owner's "Name __ <br /> ----••��-�-����-----6"�r�il-�- -- -•• --• - - -- • .---•........... ..................Phone.. ............ ....._....._._. <br /> Address ,f Lr'/'�: ----------- <br /> _._ �:.........:............... City aS' D . ............I --..........--•-- •........ t <br /> Contractor's`Nome ---,/eD../--f�.__=,�.El VO! .'.-------•............................License #01.�`,-,��� Phontt���✓�-���.. � <br /> i <br /> Installation will serve: Residence Apartment House 0 Commercial ❑Traller Court 0 <br /> Motel 0 Other ------- ---- ----------------- <br /> Number of living-units: 9 / <br /> .__i____._',Number of•bedrooms ._...._Garbage Grinder _��.._ Lot Size .... •--_•, <br /> Water Supply..Public System and name -------'-•----.......----.............---•----•------------------------------------------ .................... Private <br /> Character of. oil to a depth of 3'feet: Sond.0 Silt❑ Clay- ❑ Peat❑ Sandy Loam ❑ Clay Loam ; <br /> I <br /> Hardpan'"❑ Adobe ❑ Fill Material ....... If yes,.type ............................ <br /> (Plot plan, showing size of lot, location of.system in relation to wells, buildings, etc. must .be.placed on reverse side.) <br /> z <br /> i NEW[NSTALLATIO (No septic tank or seepage pit permitted if public sewer is available within 200 feet,( <br /> p <br /> PACKAGE: TREATMENT(y]SEPTIC TANK-[ ] f Size................................................ Liquid Depth—­..__ ......I......._._ <br /> SIII` Capacity. . ._ ..........._'-Type --------------- .... Material.............. ..:.... No.. Compartment .............:........ . <br /> 1 <br /> f, ' �- <br /> Distance to nearest.. Well .....................................Foundation .._......-__•____ ---- Prop. Line . _ ............. O <br /> LEACHING'LINE - " <br /> [ ] ._No:_offLines _.__.__•........:....... Length of each line.-----.._._................. Total Length ............................ <br /> ` 'Box __--- --_••'Type Filter Materia( .......:............Depth Filter Material .......__.._..._.._..:_._........I......... rl ' <br /> i � <br /> r ,r E r�� �• � py •k <br /> „. Distonce'�to nearest.-Well ...................:.... Foundation Property Line-:..._.................... <br /> !�;5EEPAGE.PIT [ ) ; Depth Diameter .... Number ................... Rock Filled •Yes ❑ No ❑ F <br /> '.F <br /> Water Toble.Deptli.......................................•-••--- r.Rock Size .................... ._........... <br /> Distance-to nearest: Well'.........:..............:..••____:___._.Foundation _-_,................. Prop. Line ............... <br /> REPAIR/ADDITION(Preva Sanitation permit#'.:.... ............ _ . Bate <br /> ',• iSeptic Tank (Specify Requirements) ....,�Qt ��-•:,,1� ✓�tT��Jr ��/ <br /> r <br /> ;Dis 'oral Field (SpecifyRequirements) J ` � -.•'•.--.----_--- <br /> / -- ...... ---- ....... <br /> ............................ ....................... ---------------------_-. -- . . . <br /> .(Draw existing and requited addition on reverse side) <br /> I hereby certify that I have prepared this application and that the-work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, aisd'Rules and Regulations of the San-Joaquin Local Health.Districl..Honte owner or liven- <br /> - sed agerits'signature certifies the following: <br /> I certify thaf iii the performance of the work fpr which this-permit is issued, I shall not employ any person in such manner <br /> os'to.become subiect to Workm n's,Compensation laws of Cc iifornia." k <br /> Signe :'....._: •--...•-- •---- _ <br /> C3wn <br /> By:..........:.......?' er <br /> --.. _ --.._._..---=---•------:......... Title tf 7`.<_...... <br /> Won owner <br />• FOVII)EP RTMENT USE O LY <br /> BUILDING_-�I:RMIT�155UED :: = - == 1. -- ' _l.. �.` ....... ........ DATE .�`..7..J-......... ..... <br /> APPLICATION-ACCEPTED BY ... ..... ......'.... .,.___ f- •- <br /> - ----------- <br /> /ADDITIO>�`ALt60M�V1ENTS ......... 'I-- ..._: I':- <br /> .............. <br /> •--...DATE .................. - <br /> 9. .. ...................� ...........................................................a„, ......-....................... <br /> - ..__.(.•. <br /> .__............. <br /> ....... <br /> -+ ...... <br /> ................... , - . <br /> ........... <br /> ........ .._. <br /> 4....... - s..__ .- ._•_.-.............._. <br /> in by Inspecy -- <br /> yi <br /> . <br /> SAN JOAQUIN - L HEALTH ST <br /> E. H:13.24 1-'69.Re"v. 5M _ a 1V7 �" 7/72 3 M r <br />