Laserfiche WebLink
_ ; <br /> ' > x ­ R;OFFICE USE: �_ FOR OFFICE USE: <br /> R �J I 1, r, APPLICATION FOR SANITATION PERMIT <br /> ---------------------- -------------------------- �7-.5_2_3 <br /> (Complete in Triplicate) Per <br /> No__________ _________ <br /> #; - 6 ,gV 7-7 <br /> Date Issued- ........f/A <br /> . ..___.__________ _ This Permit Expires 1 Year From Date Issued <br /> A•pp�ica#ion 9s hereby-rrrcrde-to-tl►e Sttn�oagrairt"Lov a-Heal#h-Distr•ic #or-d per i _to cornstr`�.agd_install the work herein described. <br /> This application is made in compliance with County Ordinance No. 5°49 andfexisting RbLies a�id';Regulations: <br /> w <br /> Y. <br /> JO$ ADDRESS/LOCATION -s &_ _/14 <br /> - ------.CENSUS TRACT------------- ----------- --- <br /> Owner's <br /> h-Owner's Name..._ 4J� ------=------------ ---------- -- --- - ------ Phone._. . t -- --------:..-- <br /> Address---_-_._ a 1 p <br /> � tY--- ----Zip-- <br /> �j.Contractor's_ Name.s?.,r -- - ----IY..S,.,_.0./t17�/±? .0 &_ _.r_.._p______________License Phone__4F>��-]-�-��- <br /> A. <br /> Installation will serve: Residence fief: Apartment House.❑ Commercial ❑ Trailer Court ❑ <br /> ), <br /> - c l Motel ❑ +Other---- -- `------- --------- ------------------ <br /> g �� � --Garba <br /> Number of.livin units:.._._. __'''�T�;.Number of bedrooms`__ ._ � 'ge <br /> Water Supply: Public System and game -- ---------------- --- --=------------ ----- - - ----° -- ----- ------------- - -Private <br /> Character of soil to a depth of 3 fee.-f Sand ❑ 'Silt❑ Clay ❑ : Peat n Sandy Loam `Cla,a Loam ❑ r ` <br /> Hardpan]❑,i Adobe 0 ' Fill Material]--_]' - "_.If ye's, type................- 'Clay, Loa; <br /> V `« <br /> I <br /> (Plot plan, showing size of lot, locatioriiof system in relation to wells, buildings, etc, must be placed A Aerse side.) 4 <br /> NEW INSTALLATION: (Roti epic tankor seepage pit permitted if public sewer is available within 200 feet,] <br /> PACKAGE TREATMENT [ ) SEPTICTANK"['-'] ' : Size fC�------------- --- -------------------4"__ igiid"Depth..----- ------------ <br /> Capacity7.YJ..__TYPe = , - Material No:-Gompatmens--i------= ------- -- 0 <br /> ___Distance to nearest:-Well -------=------------ --------------Foundation----------.___-.r,..=._s!'Prop'. Line-----------------------'- <br /> LEACHING LINE l <br /> [.] No- of Li es_'_--__4/1--------- of each line._____��-__-..-__-.-__-.Total Length Q <br /> 5j -. - <br /> _Type Filtdr, Material _ -Depth Filter Material --•41 ___.__ + <br /> D' Box_ -------- <br /> . . ,fir � - ..- - . �_'----_____ _. . <br /> Distance to nearest:WeII X.._� �`F,oundattbn )__" J---.__ ____Property Line_.___ <br /> ....--a.�a. ... _ . _ v . . . � .tel : ---- ----- <br /> SEEPAGE PIT h_--_' ___.__..;.Diameter. ___ Number- ______ �_ _______ t Rock Filled Yes ❑ No ❑ <br /> [ ] Dept <br /> Water Tdble'Depth----- ----- ------ Roe-V Size <br /> - <br /> - -Tt <br /> j , = - ------ f <br /> Distanceit <br /> o nearest: Well-- -- - ------------------- •�---._Foundation'--F/------- -----.Prop. Line--- <br /> 12 G__._._._._----- <br /> REPAIR/ADDITION (Prev. Sariitatin Permit ---------------------------A--------- --.Da e.---- -------------------------------- <br /> --------------------------------- <br /> -w -] <br /> Se itic Tank S ecif Requirements!)-- - -------------------------- -------------------------------- --------- <br /> P I P Y ------- ------------ -- <br /> Disposal Field (Specify Requirements)---------- ---- ----- ------------------------------ ------- ------------- V ----- = <br /> -----=------------- ------------- -----=------E -- ---! - --- <br /> ------ i. <br /> =- ---- -------------------- ------------------- <br /> �-� — `" -IDrow.-existing.•and-required addition-on-reverse side[.,; <br /> E <br /> 1 hereby certify that I have prepJred this application and that the work will be done in accordance with -San Joaquin County <br /> Ordinances, State Laws, and Rales and Regulations of the San Joaquin Local Health District. Home owner or licensed agents <br /> signature certifies the following: <br /> "1 certify that in the { I k <br /> fy performance of the work for which this permit is issued, I shall not employ any person in such?manner as <br /> to become subject to Workman"s Compensation laws of California." ._ . <br /> € t <br /> Signed ----- ------ Owner i <br /> -- <br /> BY F u ��re Y- �I------------ ---------- Title.` j�a -- � --------- <br /> (If other than owner) /"� l <br /> i FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-'.---- = DATE 707_. _ = <br /> DIVISION OF LAND NUMBER-------=-------//. -------------- ------------ ------=------=-- ---`----- -------=------ ----------------DATE---------=---------- -------------------- - <br /> ADDITIONALCOMMENTS ----.---------------------------------------------- ------------------- ------=------ --------------------I-----------r------------------------- <br /> 4 - - ----------- ------------------------------------------- ---------------------"-- ---- <br /> --_"_________________________________________________ _______ _ _ _ __ _ -------------- _ <br /> ------------ <br /> Final-Ins-inspection <br /> b �_ �, Date <br /> P Y= = -------- -- ----- ------------------------- -- -- --------------- ----- -------- <br /> EH 13 24 SAN OAQUIN LOCAL HEALTH DISTRICT F85 21677 REV, 7/76 3M <br />