Laserfiche WebLink
FOR OFFICE USE. : <br /> APPLICATION FOR SANITATION PERMIT <br /> --------- '"--`------ -------------------------------- Permit No. __-7j7_/0_5g <br /> (Complete in Triplicate) <br /> Date issued <br /> -- -- ---------------- i This Permit <br /> --------------- <br /> Applicati is hereby made.to the San.Joaquin Local Health District for,�,permlt-,jo,,consJruct End install the work herein <br /> described. This 'application is mad6 in compliance with County Ord i existing Rules and Regulations: <br /> "7t%jj <br /> JOB ADD ZESS/LOCATION .-.300-0 ---­.-F-------"�qA�_ __ kp--------------- ---------:-.._CENSUS. TRACT ------------- <br /> Owner's tJame`__ ----------------------------------------------------------------- -------------------Phone ------------------------------------ <br /> Address30 6 0­7---------F ------- ---------------F C i.ty;-------- ---------- --------- ---------------------------------------------- <br /> Contracton's Name Tqtv/v -------P-..v Bi-&&------------------ ----Licensefl# ------- -- --------- --- Phone ------------------------------ <br /> Installation will 4_eFvW7_-Z:� (17�esidrefic partm nt House F] Commercial :F]Trai-lemr-Coort-,C] <br /> f Motel f-1 Other ---------- ----- -------------------------- <br /> __j I e L --:)E <br /> Number of living units,_ Number of bedrooms _______Garbage Grind r Lot Size ACR E-06 ---------------- <br /> ----Water Supply: Public System and 'name ------------------- ------------------------- I------------------------ ------------- Private E�� <br /> -------------- <br /> -oam Ej, <br /> _Character.bfsoi I to-a-depth.of-3�feet.--.-Sand' Xlay,�Q �,.Reat-0,;.San )am'-o Clay L <br /> Sandy <br /> Silt- <br /> Adob' Material ---&V " " <br /> Hardpan E] e Ej Fill a If yes, type ------------------- <br /> (Plot plan, showing size of lot, location of system n relcition 1to wells, buildings, etcTi rnbst-be-placed. 6K.reverse side.) Lov <br /> NEW INSTALLATION: (No.sept.ic tank or seep, e pit permitted ift public sewer is available within 200 feet,) <br /> IRS <br /> '&d .Depth <br /> PACKAGE 'T -1�4k'E_j ...... <br /> TREATMENT' I SEPTIC; Size-5XV_.X�P--- ------- - --- Liqu <br /> 57--Ahaterial 49MC --o. Compartm <br /> apacity Type PEFIRr N ents ----- <br /> -----------Foundation <br /> istancd Ao� nearest, Well -------L Prop. Line ---------------- <br /> �9 s <br /> N o <br /> LEACHING LINE of Lihes ___'2-- -------------- Length of each line--- ------------ Total Length ---- <br /> Depth Filter Materia <br /> 'D' Box Type Filter Mai.erial I ------- -------------------- <br /> Distan;e/to nearest: Well Foundation --- Property Line ----5_4......... <br /> --—-------------- <br /> SEEPAGE PIT --r Depth -L.1—---------- Diameter Filled Yes E] No 0 <br /> --------------- Number ---------------------------.-RocRoc <br /> Water jdble Depth -------------- ----------------- -------Rock Size ------------------- <br /> Distance,f6 nearest: Well ----------- -----------Foundation--------------------- Prop. Line .................. <br /> I o -�(I ��, ----------------- <br /> kEPAIR/AbDITI,bll�(Prev. ifdtion Permit# ----------------- ----------- -------- Date --- ---- ------------------- <br /> Septic c T,ank (Specify Requirements) --------------------------r-`.---------/ ......................... <br /> Disposdl Field (Specify Requirements) ----- Zva----- --- 461A -------- . <br /> ---------------- ---- -------------- --------------------------- <br /> ------------------------------------ <br /> ----------- <br /> ----- ------ --- -----------------------------------------V _VC ------!-F/--- T -----1; <br /> ----------- ....... <br /> 77 -------------------------------------------------------------------------- <br /> 7N <br /> (Draw existing and required'adaition on reverse side) <br /> I hereby certify that V have prepared this application and that the work will be done in accorcldn'6!with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the;San Joaquin Local Health District. H'6"m* owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance'of the work for which;this permit` is issued, I shall not employ any person in S_U'th.manner <br /> as to becorn ubject to Work n s Compeription laws��off C.of <br /> Signed -- ------ owner <br /> ► <br /> By ------- - ---------------------------------------- �Title ----- --------- <br /> --------------------------------- ---------- ----------------- ---------------------------------------- <br /> (If other than owner) <br /> FOR DPf AitTMENT USE ONLY <br /> 77 <br /> 714 <br /> APPLICATION ACCEPTED BY _ ----------_-------- -----------------i------------------------------------- DATE ------1.1—__M. —_71-- ----- <br /> BUILDING,' PERMIT ISSUED -------------------- I --DATE ------------------------------------------- <br /> ---------------------------- ----------------•------------------------------------- <br /> ------------------------------------------------------ <br /> ADDITIONALCOMMENTI--------- --- --------------------------------------------------------------------------------------------- <br /> --------------------------- --- - -------- ------ - - -- -------------------- ----------------------------------------------------------------------- <br /> ........... ----------- ---------- ----------- <br /> - -------- ----------------------------/W_-,�!, <br /> ---------------- t � -------:--------- <br /> W. V 7 <br /> --------- ---- --- --------------------------- <br /> - -- - ----- bate ------- -------- <br /> --------- ----- ------ - <br /> Final Inspection by ----------- -- -- ----- - ---- - - -------------- --------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />