Laserfiche WebLink
F <br /> FOR OFFICE USE. OR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ---------------------------------------------------- Permit No.7777-.75_�4 <br /> i <br /> (Complete in Triplicate} <br /> --------------------------------------------------------- Date issued.. -1 27 <br /> tl -NThis Permit Expires 1 Year From Date Issued <br /> -----------------I--- ------------------ <br /> Application is hereby made fb ihe_Sah-Joo9u' in- ,LdcaI HY&-aith,'IDiStTiWfor,4a permitto construct an&instdII the work herein described, <br /> �1_ <br /> This application is made in compliance 5 sti kulemnd'Ri ul-6tions: <br /> ,��A County Ordinance No. 49 and ExisfinJa <br /> .PIN A; <br /> - --- ------ --- <br /> ------------- <br /> JOB ADDRESS/LOC-ILT 7-f?� ------- -- .... --- ------ ----- ------- -- <br /> - - ..--.CENSUS TRACT. ' - - <br /> Owner's Name._- ---- -- ------- -------- ------------------------------------------- Phone---- ------ --------------------- <br /> city <br /> Address---- -- - - --- - ---------- ---- ------------------------------ ----------- -------- ---------------------Zip--------------------------- -- <br /> --- - - ----- <br /> Pl4one./?.I/�� ... ------ <br /> Contractor's Name--.------ - ------------- -------------- -----License, 4 <br /> Installation will.serve: r Tra i Ier Court <br /> Residence p tment House.Ej Commercial Ej . ,-2 <br /> ."A <br /> k C \ . - - - <br /> -go t6 ITL Other-=---------- -- --------------------------- <br /> --- ---- --------- <br /> Nu'mber of living units:--------- ------Number.of.bed1&oms_._,._5----Garbage Grinder------- ----Lot Siz --- <br /> Water Supply: Public System,and`name.:__:---------- - ----------------------- --- --- --------------------­----------- k,4------------ P r iva <br /> Character of soil to a depth of 3 feet: Sand E) Silt E] :Clay F] Peat 0 Sandy Loam b C14 Loam-1-6 <br /> -. - 1 <br /> Hardpan F-1 Adobe F-1 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-reverse side.) <br /> NEW INSTALLATION: jNo'septic tank or seepage pit permitted if public sewer is available within 200 feetj <br /> --Liquid Depth_i(-- ----------- <br /> ------------- ---- <br /> PACKAGE TREATMENT SEPTIC-TANK -- ---- - <br /> --No. Compa rtme n <br /> Capacity--/ pe-L-19--------f-Material--- <br /> -- -------- O;L<------------------ <br /> ----------- <br /> Foundation--- Pr�p. Line----::r --------- <br /> :Distance to nearest: Well._;__V_00-- ------------------ <br /> LEACHING LINEA No. of Lines-----I . <br /> ... ----------)----Length ofeach-liTotal. Lentgth.' I-1- 4t9---_ --------- -- <br /> ..........neI,�� <br /> rs� <br /> p r Maferiblt.... <br /> D' Box-- - --------Ty� e Filter Mat6rial------------------- Depth Filter ------------------ ----------- ------ <br /> Dista: rite to,nearest., Well- -----Foundation--------------_---.---_--.-Property Line--.--- ---------------- <br /> SEEP !T No E] <br /> D.p1hA_X/,*,,X..6..e1er---- -------- ------Number----------V-------- ock Fil I ed Yes No <br /> Water taSIe'.beptIk___ ----- ...._-Rock Size'- <br /> -------- - ------------------------------ <br /> t. <br /> Distance:to nearest: Well-'--------------------=- --- ----------Foundation--------- ------Prop. Line.--------------------- - <br /> REPAIR/ADDITION (Prev. Sanitation-Permit-#-------------------------- ---- --------Date--------"---------------'--------------------) <br /> Septic Tank (Specify Requirem;ents')_-___L. ------------------ -------11,4--------------- ------------------------------------------------------------- <br /> {41 --------------------------------- <br /> C4, <br /> Disposal Field (Specify Requirements):---- ---------------- --------------- ---------------------------------------------------t <br /> ---------------------------------------- <br /> 7>------------------------- <br /> ------------------------------- <br /> iL------ <br /> --------------------------------- ----- ---------------------------------------7---------------------------- <br /> ------------------------------------------------------ ---------- ------t---------i----------- -------------- ---------- <br /> --------------------------- --------- ---------------------------------------------------- <br /> (Draw existing and required addition on reverse side) <br /> I h;reby certify that I have-prepetred this application and that the work will be done in accordance with San Joaquin County <br /> Ordinances, State Laws, and Rules and Regulations of'they Son Joaquin Local Health District. Rome owner or licensed agents <br /> signature certifies tke following: <br /> "I certify that in th-6 'performarice of the work for which this permit is issued, 1 shall not employ any perion in such manner as <br /> to become sub�fect to Workman's C ensation' laws of California.". <br /> wner <br /> Signed------ ----- ---------------------- <br /> By- --- --- ----Title------------ -- -------------------- - -------------------------- <br /> o- h-e-r- anowner} <br /> ODE <br /> TME T !:!�EPNO <br /> APPLICATION ACCEPTED BY-. ----------- ---DATE.-- ---------- <br /> ----------- --- <br /> --- ---------- ------ -----6---------- ---------- ----- --- <br /> DIVISIONOF LAND NUMBE -----------------L------- ----------:----------------------- -------:--- ---------------------------------DATE-------------------------------- ------- ----- <br /> ADDITIONAL COMMENTS - - - ----------- ------------------- --- -------------------I------------ ----'---------- <br /> ------------------------------- <br /> --------------------- -- -------- -=-=------- - ---- - --------------------------------- - <br /> ---------------------:-- -------------------- --------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------ <br /> -- -- <br />.0-- ---- <br /> -------------------------- ------ - ---- - ---------------------------------- --- <br /> Final Inspection by:. - - - - --- -------------Date-.-- - - ----- ------------ ----- <br /> F&S 21677 REV. 7/76 3M <br /> EH 13 24 N JOAQUIN LOCAL HEALTH DISTRICT <br />