Laserfiche WebLink
j <br /> FOR OFFICE USE: <br /> APPLICATION FOR SANITATION- PERMIT _ <br /> Z <br /> 1-0 (Complete in Triplicate) Permit No. - ------- -- ------- <br /> ------ <br /> _________________ ________________ This Permit Expires 4 Year From Date Issued Date Issued _�--__`f=__7.1/ <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This application is//-�mmade in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATI N _.1-- 77-----F---------Fri-EWCM------CAIT--------PD>__--.CENSUS TRACT ---J-`_ ---- ' <br /> r <br /> Owner's Name --- - - --Q_U�,^�-----------B��uI.------R_;-----•-----r-�-,-------••-------------•-------�-j- --�I-Phone -------------------------- <br /> --------------------•--- •--------- <br /> Address -----11/5-77----- r= FR_iF� [ ►------ Ps---AY_..._. City --------��--r-a j----------------------------------------------- <br /> Contractor's Name ------0-W_-IV F_RN ---------- ------- ----------License # ------- ----------------- Phone ------------•-------------- <br /> Installation will serve: Residence [PI�partme`nf-House,,,❑ C,ommerc'ral :❑Trailer Court ,❑ <br /> Motel ❑ Other ------------ -------•---------------------- p f <br /> Number of living units:---- ._.__ Number of bedrooms -____ Garbage Grinder ,Lot Size f11 _ _.-__....... <br /> Water Supply: Public System and name ----------------------- ----------------------------------------------...--------------------------------------Private t[� <br /> Character of soil to-adepth of 3 feet: Sand'❑ .. Silt. —Clay :0 Pent❑­�-Sandy-Loam;-❑- - Clay;Loam.;[__�_7—'.— <br /> Hardpan Adobe-E] Fill Material -/x-49- 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 /> NEW INSTALLATION: (No septic tank or seepage pit permitted if publi sewer is available within 200 feet,) <br /> PACKAGE TREATMENT { ] SEPTIC TAN _______________________ Liquid Depth ----------------------- <br /> ------------- <br /> Capacity <br /> ____________ <br /> �[_]w..._,._ Size--------------- -------- -------- � <br /> Ca acit J._ Type ___-__--:__--____ Mated I----------------- No. Com artmentss ___.____.._ _ <br /> P Y YP _� P - V <br /> Distance to nearest. Well --------------------------------- __Foundation ---------------------- Prop. Lime ____________.._....... V' <br /> LEACHING LINE [ ] No. of Lines __._ _-___ ._--Length-of..,eaclh ie------------- _' _------- Total Length <br /> ----------------------- �F <br /> D' ox ---- _.____ ype Fitter aterial _______.-__- ___ `Dep�h Filter Material ------------------ -•-----------•-_-_---•- <br /> Distance to near st: Well ________________________ Found tion _--------- Property Line,:- --------------------- <br /> SEEPAGE PI { ] Depfh __------------------ Diameter \-------------- Number ____---------- ------------ Rock Filled Yfes;0 No i❑ <br /> Water Table Depth Rock Size ------------------- •-•--- <br /> ((( <br /> Distance to nea t: Well ------------- ----------------•----. ..FoundaYlori>;� ----_- _ Prop. Lime_-------------------- <br /> p <br /> ________.______---- <br /> i.�=�t <br /> REPAIR/ADDITION(ire . sanitation Per J -c_ ___l ate.___________ _!_..__._._____ _:} <br /> Septic Tank S ecif a uirements) ----- ---------------------------I t !111. <br /> -- Y� � <br /> P I P Y q = r <br /> c' - ] <br /> Disposal Field. (SpecifyRequirements) __ _ _ QNL_ -- --7`%41UJ - ----__ ®------ �C7--- -t�� <br /> _ ��- - - NF1-��------ -lr-- � - - <br /> ---------- <br /> — --- <br /> - Lt_N F ._ s36_ --RGac�l/� —,� r k��.`� `��-[F QU N__ - l4RD"` f N <br /> . <br /> 1 �a. , <br /> (Draw existing and required addition on revers) side)) �� .��_� t <br /> I hereby certify that have prepared this appy anon and 'thivt the work will bel done in acco d"ante ,rnritli San Joaquin <br /> Count Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health Distfict. Home owner or licen- <br /> sed ag" nts signature�ertifies-the-following�"-- <br /> "t certy that inl the performance of the work for which this permit is issued, I shall not employ any person in such manner <br /> as to come subject to Workman's Compensation laws of California." <br /> Signedi r -------------- Owner <br /> 1 <br /> - ------------------------------• Title --- i - -------------- <br /> (14 other than owner) <br /> FOR .DEPARTMENT USE ONLY j <br /> t --- --- T <br /> APPLI =ATION•<ACCEPTED 8Y ---- �- �-�_`�-�--- ------------------------------ --- -------------�----. ❑ATE _--.--- �- <br /> BUILMNG-•PERMIT ISSUED-� — _ `= �-�' :. --- <br /> ADDITIONAL COMMENTS ..... <br /> - ------I '- =" w —--------- - ---- - ------------------------ i ' b V -------------------------------------------- <br /> ---------- -- --------------------- <br /> -- ----------------------------------- <br /> f }jv1.►i-�i` J it�!! 1 \ �i <br /> ---------------------------------- <br /> ----------- --------- ------ ------------------------------- ------------ --- =`—.------- - ...... <br /> --- <br /> --------- - - ---- <br /> --------- - - --------------------------------- - � ------------------------------ <br /> ; 4 SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E:y;9 �18 Rev '5M <br />