Laserfiche WebLink
FOR OFFICE USE: FOR OFFICE USE: ) <br /> APPLICATION FOR SANITATION PERMIT TIC <br /> --.... Permit No....UU_........... <br /> (Complete In Triplicate) -- <br /> rryy <br /> Date Issued..,7-16_-'7g <br /> -•----------.................-----.--.---.--......... .. This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION............... �.j... ... .1.,-.K-, . -1........;.....?...CENSUS TRACT......_-... ....- ...... <br /> Owners Name �l,Tr'1A . —+-----•—iT�Phone <br /> —••— �. ....... ... p <br /> Address ti..,, ..c. ...- .... Gt.. 7�,i� { i <br /> / r-i . .. . i :.S .... <br /> Contractor'l Name ..........! .�rl L, .�.'1� �' .._"—'?'.License <br /> Installation will serve t Residence JV Apartment House' Commercial E] Trailer Cou€t'❑ ` <br /> i 1 ( • ' - Motel ❑ 'Other.:.. ..��_ 5 ........ ...r.- a <br /> Number of living units !/ !.....Num)br of bedrooms." ??� U} C t T <br /> �t! s�..+......Garboge Gjmder ...... Lot Size .. ¢ <br /> Water Supply: Public Sykmt and.name.'......----.......----`-.......... ............_....._ ...... -i. -.....Private............... <br /> ;- <br /> .....(........ <br /> 1 T '- ' '.� <br /> Character of soil to a depth`6w feet: Sand ❑ �SIVC Clay [] Peat j] Sandy Loam❑ 'Clay Loam ❑ } <br /> t <br /> j I Hardp ,,❑ 'Adobe E] Fill Material.._.........if yeg's,type...._...._ ............ <br /> IPlot plan, showing size of lot, location of system ,nidation to wells, buildings,etc.must be placed on reverse siA) <br /> NEW INSTALLATION: - <br /> t(No.septic tanN�Or seepage'pitpermitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ 1 SEPTIC TANK "Size....�.................................................._Liquid'Depih ............... <br /> Copacity.....�.:�....��.aType 1 ._fes Material :.No. Compartments_ - -- <br /> .,. ( �+ 'ice -t- . ... .. <br /> . � .. Di tanceYoJ earesh. `Y ............ ......Foundation�.. .r.i9..............Prop L1ne.{... ... ... _ <br /> LEACHING LINE' Nd i r t t rQ <br /> J.,1.. r ofJLng ....., ......'a..., ...}Leng hi _of each line... rTotal Length., :: -':-..-............ :,.. <br /> • 'D' Box..... Type Filter viat ia{ , Dept~h Felt r Material... �� V ( e .........................-- _ -- --.-. <br /> Distance to nearest. Well -- p s <br /> oundatlo`5i .._ .., Proper <br /> SEEPAGE PIT j J Depth ..Diarreter���, ' -.,.NErm6er�--- } `ti i. --- - {Zak Filled' Yes❑ No❑ <br /> �qy 1�. _ s <br /> Water Table:Depth .... -2' - ---- .. Rock Size .. . �.�.-r.-.... .:------- <br /> Distance to <br /> Disiante'to nearest Well eC 'Foundation ......... . Prop. Line f`Ki3..l) <br /> REPAIR/ADDITION (Prev. Sanitation Permit# .........{, - .:. ... Date.. ..... <br /> Septic Tan O(SpecifyRequirement <br /> s)w.. l!'Q... <br /> Disposal Field (Specify Requiremdntsh J >dG ` } <br /> r...... ... . :... ... . ...... <br /> ' 1 _ <br /> __..:....._!.__,.0:...:., ..-' ..... - - -------- ..................................- ... . ... . I <br /> _. ;-- l . _ <br /> [r (Drawtewsting and required addition on reverse side) <br /> I hereb cert that f.have r ' t - <br /> Y lily peps this aP Ilc tion and that the work will'.be.dopey in Fac`tardance with So� Joaquin Counfy_� <br /> Ordirtariees, State Laws, and Rvles and sAegulanens of the San Joaquin Local Health`D)st t, Home owner iOr licensed agents <br /> Signature cerrh'fies the following • - --- - <br /> � \ .` *; <br /> "1 certify thcf in the -performance of'the work for which this'permit is issued;i shIll pot-employ any peroon i such in as <br /> to become,,subject to W m $ Com sation laws of.California." <br /> ;. �' <br /> i r <br /> Signed . ....} !r'i r- 7'A%"iL . :U,vne�r `Jt�iti\y <br /> t t <br /> By... 1 tle`R <br /> . ..... <br /> I ... (If other than"owner) <br /> f - <br /> _...... _, _....�... .:.. . .DEPARTMENT USE <br /> � <br /> . -- ". ONLYiAPPLICATION ACCEPTED-BY.:.f .. r.-- ... ............ -` ----------....DATE.: :.�.. --*.. G6....... <br /> ) <br /> \ 1 <br /> - <br /> DIVISION OF LAND NUMBER:......:...._.;.i............:......:.....�........._.. ..__-i- '-....,................._...:...DATE.`_..._..... .. 1 <br /> .. . . _.... .. ............. <br /> .......... ... <br /> ADDITIONAL COMMENTS..... ......_.,................... [ .. <br /> ' i---� •........................ <br /> _... .................... ............:�.... 6.....:..... ................. <br /> 1 I .. ........... - ..: ........._...--.-'."--......._....,:......._.................,.....!... <br /> ."n"spectio..-by;. _. ... .. .. - -....................... - -' ' Date.7.-'6i- -' '-"- <br /> Final.lns ection•b ... .... c -...- --- <br /> EX 13 2, SAN JOAQUI LOCAL HEALTH DISTRICT E F65 21677 REV.7/76 3M I <br />