Laserfiche WebLink
FOR OFFICE USE: ! I FOR OFFICE USE: <br /> ✓ APPLICATION FOR SANITATION PERMIT 73,, �7a- <br /> (Cemplele In TrIPlitate) Permit No. <br /> I Dale Issued <br /> This Permit Expires T Year From Date Issued <br /> Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance witch County Ordinance No.5499 and existing Rules and Regulations: ^_ <br /> JOB ADDRESS/IOC�QJTION a 17 G [ +v��Oa r"' CENSUS TRACT, 4eA1A <br /> r Owners Name /1 �/O/, CJ�UCi�.$.E/tJ .. Phone 3-;1.`./�O�S.�....--- <br /> S33 to Ac/o A/ " city Ac/9ie� Yip.SJ�Aq <br /> Address ._ ......_..... <br /> t �s 111 �- C- <br /> yp) Controctors Nome 644 &14^ �i9)�1--✓4+C License # ,3u.S7.L/. Phone <br /> i Installation will serve_ Residence Apartment House Q Commercial❑ Trailer Court Q <br /> f{ Motel Q Other - -- <br /> Jt Number of living units: / Number of bedrooms �' Garbage Grinder LW Size, <br /> Water Supply:Public System and name _._ _____.......... ...............Private�- <br /> Character of soil to a depth of 3 feet: Sand Q Silt❑ Clay E? Poor❑ Sandy Loom❑ Clay Loam Q <br /> Hardpan Q Adobe Q rill Material . If yes,type _... . ..__....._ . <br /> (%or 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 public sewer is available within 200 feetd <br /> PACKAGE TREATMENT I ) SEPTIC TANK I I Size . - - _.._ _......Liquid Depth . . .- __------------ <br /> .: Capacity Type Material No. Compartmenri1 <br /> • Distance to nearest:Well - Foundation... ... _...... ._. Prop. Line_..._........_... .... <br /> � <br /> .Total Length.-.._._ .. 1n1:.` <br /> [ 1 No. of lines . . - length of each line - - Le rtg - -- ""' <br /> LEACHING LINE <br /> 'D Box Type Filter Material.._ . _... Depth Filter Material ---. Una -- .-- <br /> ! Distance to nearest:Weil... - . <br /> Foundation ..Property --"' ... ....." <br /> SEEPAGE PIT [ I Depth Diameter. Number Rock Filled Yes❑ No Q�1 <br /> Water Table Depth - Rock Size ...._........................_... <br /> t Foundation ...Prop. Lina_ ............... <br /> Distance to nearest:Well .. <br /> REPAIR/ADDITION lPrev.Sanitation Permit I .. _. .. __Date <br /> Septic Tank ISpecify Requirements) .... _. _._........................_ <br /> Dr Field (Specify Requirements) 7 / <br /> w.nE gas f _3G '� .��. _. . . <br /> _..._.......... _ <br /> _......... ....... <br /> ... <br /> (Draw existing and required addition on reverse side) <br /> 1 hereby oerliFy than 1 have prepared this application and that the work will be done in accordance with Son Joaquin County <br /> Ordinances. Slate Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licensed agents <br /> flgrsature wiffs"the feHowing: <br /> 'Y certify that In the performance of the work for which this Permit is issued, I shall not employ any person In such manner as <br /> to become su Ir to mon s Compensation laws of California." <br /> Signed .Owner(04211-1Z, <br /> Title ..J).. <br /> (If other than owner) <br /> er- w' <br /> FOR DEPARTM SE ONLY __ 7 <br /> _ -- =— <br /> _ .... .DATE <br /> gPPUCATION ACCEPTED BY � '- DATE <br /> DIVISION OF LAND NUMBER -- - - - - <br /> ADDITIONAL COMMENTS . .. ........ .. <br /> _...-.__... <br /> .... .... _ __ .. ... ... . _. .. ... .. .............. ....... <br /> Date / ..... `. <br /> Final inspection by: .. .. <br /> m is t, SAN JOAQUIN LOCAL.. ALTH D1TjTRICT nli T!n REV, >ne sw <br />