Laserfiche WebLink
_ FOR OFFICE USE: <br /> ` "............. - APPLICATION FOR SANITATION PERMIT FOR OFFICE USE: <br /> - (templet* In Triplicate) Permit No.79-.[O/ <br /> -- <br /> I <br /> ''this Permit Expires 1 Year From Dot*Issues' , <br /> - Date ssued. <br /> 4F ication is hereby made to the San Joaquin Local Health District for a permit to <br /> co �— <br /> h—OPPlication is made in complionce with County Ordinance No.549 and existing Rules and Regulations: <br /> construct and install the work herein described. <br />'Oa ADDRESS/LOCA TIC1�,�. r f �f <br /> .. Q <br /> sr's Name.... . .. . "_. K..... .._. .. .....CENSUS TRACT._. .. <br /> v`Gp�-3t�....... - ... .. <br />+drTiess. . .... ... ..... Ph <br /> �— .� _. ... ... <br /> ... . . . ._ .... . one <br /> ... . I� n .. . .. . <br />'or*•actor's Name...... .."` /C.c{. . . .Zip <br /> 7�� A _t <br /> isf lotion will :cave: �.�.c�_? �� ��-���"� . License # �'2 22 (e.. .Phone. <br /> Residence❑ Apartment House❑ Commerc al❑ Trailer Court ❑ `..- - <br /> Motel 0 Other. <br /> umber of living unfis:....... ......Number of bedrooms <br /> •.Z... Garbage Grindrr._.. .. ..Lot Size__.........C•-tti.�_.�._.� <br />'af Supply: Public System and name... - "." .. .�.�-.:.._"-...._.., <br /> ra'la'cter of soil too depth of 3 feet: Sand - ......... Private L� <br /> . . .......................... <br /> ❑ Silt❑ Cla .] <br /> Hardpan Adobe Y❑ Peat❑ Sandy Loam❑ Clay Loam❑ <br />— _ _ ❑ Fill Material..... .... .lf Yes,type................... ... . " <br /> ut on, showing sizo of lot, location of systemin relatio—buildings,etc.must be placed on reverse side.) <br /> YiPTNST�TION: (No septic tank or seepage P <br /> CKAGE TREATMENT Pit Permitted if public sewer is available within 200 feet,) <br />— 11 SEPTIC TANK Is� I / r r <br /> Size......5_.._..'y-).�.........x...-477.........Liquid t- <br /> Capaciry...��o_Q_C2....Type_�... eJt_� uid Depih�y,. <br /> Distance to nearest: Well. .__. _ �--No. Compartments.................._............_. <br /> ACHING LINE / 50 ...Foundation. .. �O_� .... . .Prop. Line .S <br /> [❑ No, of Lines. _r,3. Length of each line... . <br /> GT....... .. Total Length.. .. 1.�Q_ <br /> r <br /> 'D' Box I- _.Type Filter Material....._5...fZ%-..Depth Filter Material........"./"4,.. ...._... ._- <br /> '/ Distance to nearest: Well........ r <br />'AGE PIT IK1 Depth ^ + . oundation....._....L:b..-........Property Line.......,,�J <br /> ameter <br /> - -3 ....Number ..... ,�. Rock Filled -" <br /> Water Table Depth ......9� / l/ N <br /> ❑� <br /> ' -- ..Rock Size <br /> Distance to nearest Well j_�� ' -................s <br /> UR/ADDITION(Prev.Sanitation Permit#.... - ' Foundation." /(, � / <br />_ Prop. line.....__...._.. <br /> is ink (Specify Requirements) - ".-- .. -- - Date. -- -- - <br /> osa Field (Specify Requirements) - - - <br /> raw existing and required addition on reverse side) <br />'by certify that 1 have prepared this application and that the work will be done in accordance with Son Joaquin County <br /> to as, State Lows, and Rules and <br /> certibq the following: Regulations of the Son Joaquin Loccl Health District. Home owner or licensed agents <br /> tum <br />•tify that in the performance of the work for which this permit is issued, I shall not employ an <br /> cE' a subject to Workman s Compensation laws Of California." P Y Y Person in such manner as <br /> d,{ <br /> . .. ._. .. ...Owner <br /> .... 4/c <br /> /• .I.�y.L. <br /> pTitle <br /> f other than owner) Q <br /> FOR DEPARTMENT USE ONLY <br /> 'ATION ACCEPTED BY. � - <br /> ON OF LAND NUMBER DATE-- 7 — <br /> IC AL COMMENT$ DATE <br /> - - r <br /> _..._.. . <br /> n :chop by: . <br /> / Date <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT f/ " <br /> id])6»REV.7»0]M <br />