Laserfiche WebLink
FOR OFFICE USE: FOR OFFICE USE: <br /> APPLICAT16U FWR VANITATION PERMIT • <br /> .............. <br /> (Comptate in Triplicate) Permit No...7. <br /> L <br /> Date Issued.//74-77 <br /> -------------------....................... This Permit Expires S Year From Da*V',1 sued <br /> V } <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 Rule's and Regulations: <br /> -�- - ---rte-._- ©©.. .. ._ _ — — <br /> JOB ADDRESS/LOCATJON__.. ��_7D....�C.'. CENSUS TRACT_... _.._ .. <br /> .. ................. <br /> Owner's Name.... 3 -Phone_3_61 -�.Z_ ... <br /> ---------------------- <br /> Address----- -2.09.............. City caG.!' ...............zip-.Fc�_: .7 v.,_.... <br /> Contractor's Name__' 7E _._ .......................... #..3_.,5'7i91.....Phone.,3.6,A3 ... . <br /> Installation will 'Se•rve:` Residence[;}Apartment House❑ Commercial ❑ Trailer Court ❑ <br /> k , r Motel ❑ Other......................... ------ v <br /> Number of living units:..;-------------Number of bedroorns,.3 _.Garbage Grinder------------Lot Size-------- 4,a............................... <br /> Water Supply: Public System and name...................:.. - ......................... ----------------------- ............................ ..----...Private (� , <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay❑ Peat❑ Sandy Loam C]...Clay Loam gj� <br /> 1 Hardpan ❑ Adobe ❑ Fill Material.............lf ye's,type.............~.'_ - <br /> 13 <br /> (Plot 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 isf Vailable within 200 feet,) C-�-- <br /> PACKAGE TREATMENT [ J SEPTIC TANK' [�-� Size_...c _h'__ ._.. '_4 fJr�.. Liquid Depth....01.............. i <br /> Ccpacity.__1-4C,�7.41.'Type. ...........Matwittl­- -- Compartments.....�....................... <br /> Distance to nearest: WelLr���r I :p, t. -,/ r d <br /> ........._..Foussn��dation..:. Prop: Line--,/ <br /> LEACHING LINE 3 _Length of each line...__.._.k4o ! m <br /> [�}!No. of Lines.._._. . ..-•. - .•• .- • !. . Tbrtsal ngth.:....:lxZ�_._.._......• --..----- <br /> ! 'D' Box.fy ..Type Fi'ter lvlaterial. ��,�LDepth Filter Material_._a ................................::.............. <br /> . . :... �. i. .. <br /> p .. <br /> Distance to nearest: Well. f. .....:.......Foundation_.. 4_�.___..___....., • perty Line...P.._......_._._,__:_._......... <br /> � <br /> SEEPAGE PIT [,4—. Depth_.-,5`....Diameter.. .at ,. Number... .._._ Rock Filled 'YesNo 'f <br /> Water Table'Depth-- #Z [...........Rock Size._._ _. ! .. , <br /> Distance to earest: W6111— ' .._"-`��".......Foundafion.f..e?r0..�:.._.......Prop. Line---- <br /> Ir <br /> ine____ <br /> REPAIR/ADDITION{Prey. Sanitation lPer.•mit#'.........:....��� D'ate__......1'......------'.--..�.:'_..____...__.} <br /> s <br /> Septic Tank (Specify Requirements)--•--...... ...............I-----------••---_--../.. = : ....:..........:....------..------•-------------------------- -- <br /> Disposal Field (Specify Requirements):._......A � ;``= ----...... 1 :; --•-•---•---••---•--- __..... , <br /> .-- <br /> P <br /> -----------•--------------------------------- --•------ -------- -- <br /> ;- - L-•-----i <br /> .'(.Draw existing,a{{nd requ4t�d_addAi,6.on reverse side).- I _ <br /> I hereby certify that 1-have prepared this('application dnd thatllt'o work will be done in p�cordanc with Son Joaquin County <br /> Ordinances, State Laws' and Rules aRegulationst,of the' S6 Joaquin Local Health District. Home owner or license&agents pp <br /> signature certifies the following: : 1 i+ <br /> "I cern that'in the ` I <br /> certify performance of the'work for which this�permlt is issued, I shall not employ any person in such manner as <br /> to become subject to Workman's Compensation .I"s!.of.. Cc1`Iifornia.:•` <br /> f, <br /> Signed-- - 1........Owner <br /> BY=------ �, �, Title...tr...... <br /> ....... ... 4-�'t '......._... , <br /> (if other than owned - { <br /> c <br /> F 'FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY____-- _ ��, . __. _ _ :__.-----------------------.----_DATE _.... ._ .._`"�. ,?:."... -_-•- • <br /> DIVISION OF LAND NUMBER................................... . . ------........._....._.._..._.................DATE........ ..........:_.... = <br /> ADDITIONAL COMMENTS--. ............... _...._..... .................---:....--------------•--•---......---...........----.._........--••----...... _._,... <br /> i <br /> ......................................................•------•-•-•---•---..........._...------•-••--••---••---•----•------...........-----•---...-•-•----:........ --- ----.......................... <br /> .................. ---•---•-- - .. ........ ....... <br /> ----- -•-----•----.................................. ----­---------- ._...... _ .... .......... --....�.........--.--.-..----.-..--.-.-.-.-.. <br /> - <br /> -- / ; <br /> Date. <br /> Fnal Inspection by: ---------- <br /> EH 13 2.1` F65 21677 REV.7176 3M <br /> * SRN JOAQUIN OCAL HEALTH DISTRICT <br />