Laserfiche WebLink
r,�k OFFICE USE <br /> APPLICATION FOR SANITATION PERMIT r' <br /> (Complete in Triplicate) Permit No. 7�r...... <br /> Ij <br /> =t� <br /> Th(s Permit Expires 1 Yom From Dote Issued Date Issued <br /> APpljcot on is hereby made to the San Joaquin Local Health District far a permit to construct and install the work helele yk <br /> Jescr bed This application is,lmade in compliance with County Ordinance No. 549 and existing Rules and RtrgultdWft <br /> -06 ADDRESS/LOC ION <br /> G.vnNr's flame � / (po�. ! 9 �• 1 �i� `,L� h�eq <br /> a CENSUS TRACT ... ... <br /> ��G��.D ; <br /> Address Phorlt <br /> yC a y r .. ` ."................. <br /> Ale city G 4de i1 aq <br /> Contractor s Name Re 14 red license #A ftv7/ mom <br /> Installation will serve: Residence[]Apartment House❑ Commercial ®Trailer Court 0 <br /> f, <br /> Motel <br /> tJumter of living units: Number of bedrooms ..Garbage Grinder Lot Size L� <br /> Water Supply. Public System and name PK <br /> . Prwote y,. <br /> Character of soil to a depth of 3 feet: Sand C Silt 0 clay [] Peat(] Sandy Loam NJ Clay Loom 0 <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 revww side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted <br /> � �iff public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT ( 1 SEPTIC TANK( ; Size 7` ;4` ;-.e6-r <br /> Liquid Depth '15W r� . <br /> Cupocity/2"V TY _+� Material_,, . .� <br /> p - No. Comportments «:-Z..-. .. -... �-' <br /> Distance to nearest: Well n <br /> /Jr Foundation 2-4> � Prop. lint /T 0.! <br /> LEACHING LINE f ; No. of Lines .2-- <br /> Length of each,iine SSS Total length <br /> 'D' Box Type Filter Material�� _ Depth Filter Material <br /> Distance to nearest: Well 80 Foundation r Property Line. 6d <br /> SEEPAGE PIT ( 1 Depth .2-aS Diameter .�.� .r Numbe• `�. r Rock Filled Yes No C, <br /> Water Table Depth Is Rock Size//i. �,/ <br /> i <br /> Distance to nearest Well ....Foundations Prop. Line <br /> REPAIR/ADDITION(Prev. Sanitation Permit# Dote ) <br /> Septic Tank (Specify Requirements) <br /> Disposal Field (Specify Requirements) j <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will be done in accordance Wilk Sow Jot We <br /> County Ordinances, State lows, and Rules and Regulations of the Son Joaquin local Health District. Horne owner of lisess` <br /> sed agents signature certifies the following: - <br /> -I cer+ify that in the performance of the work for which this permit is issued, I shall not employ any person IN such toner <br /> ..s to become subject to Workman's Compensation laws of California.,, <br /> Owner <br /> Title <br /> i �ti,er tho owner) <br /> r.-L. <br /> FOR DEPARTMENT USE ONLY <br /> PIED BY <br /> i ISSUED � jDATE -" Jay <br /> � DATE <br /> Gale —�� �v <br /> SJOAQUIN TICAL HEALTH DISTRICT <br /> // 7/7231 <br />