Laserfiche WebLink
r� r <br /> -rig " ZZ FOR OFFICE USE: <br /> FOR OFFICE USE: ppptlCAiON R SANITATION_PERMIT l6 / <br /> P r �� r Permit No..__--70-•'� - <br /> ------------------- ---- - - (Complete in Tri licat`e1' <br /> p <br /> Date Issued_. 4--7d' <br /> - <br /> This Permit Expires l Year From Date Issued <br /> l <br /> Application is hereby made to the San 1odG'CoLocal unty OrdintanccesNo. 549 and existing Rultrict for a permit tes and Regulations: work herein described. <br /> This application is made in compliance with Y m �- Q�,/ k ' <br /> - - . <br /> - - �"�/--:------ --.CENSUS 7RACT��"- ----- ------ ------ <br /> JOB-ADDRESS/LOCATION._.._-_ ___-___ " <br /> � - j /rC'�--------------- <br /> -- --- <br /> --- '•---:�.- - -- one <br /> owner's Name--.--- -- - <br /> `G ------ --- - � ----- ---- <br /> � ! � Z i p- <br /> Address--- ,_ zlioxv. E, l <br /> s Phone_ i <br /> ---- License#_._�. <br /> Contractor's Name--------- ---;-- -- : ; e <br /> ..... <br /> lnstallation will serve: Residence 0 . Apartment House❑ Commercial ❑ frailer Court•❑ <br /> - 'Other--,,''`' ---- ------ ------- <br /> _4� . Mote{ ❑ , g , <br /> f � Lot Size---------- '----- --° 1------ <br /> Number of bedrooms- •----------Garbage GrmdEir.-. -----;- <br /> Number of living units---------- ---- - ---_ -_ ----_--_Pr�vats <br /> El <br /> --------------------.L_'--- - - <br /> --- -- -- -- <br /> Water Supply: Public System and name -.r=_ ------------------------------ . Peat❑ Sandy oam ❑ Clay Loam ❑ <br /> Character of soil to a depth of 3 #eet: Adob❑ Fill❑Mat Y 1 <br /> Silt Clay <br /> .. Material -------1f YeS, type-- -- ------ ------ --�--- <br /> ,Hardpan ❑ ❑ f <br /> Plot len, showing size of lot, location of system in relation to wells, buildings, etc. must be placed an reverse side.) v f <br /> (plot <br /> (NoSi6ptic`tank or se�ge pit permitted <br /> `iff public sewer is availab� `2Dfl feet,) <br /> r �Sielf�'.-[ _ n C' : "liquid Depth ------------------------- <br /> PACKAGE-TREATMENT ] SEPTIC TANK wl / <br /> Capacity:_.-__h. --TYpe == ' Material----------------= No: Compartments <br /> {' ----=--- - ----Pro LineFoundation_._ P , <br /> s ,a�.Dist'nc nearest:.Well = <br /> --. <br /> o. of Lines.:-- - Length of each T h"` �� <br /> ��� . : e n <br /> Total L gt . <br /> i LEACHING LINE. /,'� = ~- ----- - - -- - <br /> jf' f <br /> D' Box__._-_.__ 7 e Filter Material -.-_:_-_ Depth'Filter Material,_ J <br /> Ir lsrl ... ... : . dat C'� Pro— k Filled N <br /> ✓ oun <br /> € ` Distance..to nearest: Well--------.------ <br /> Rock <br /> - '-- Roc i <br /> ion. <br /> Yes ❑ o <br /> Property Line_- <br /> t ---- - <br /> ' "> <br /> SEEPAGE PITS [ ] Depth----- ,Diameter _-- Number-_-- i " <br /> . `` �- �^r __ ------------------ - ---- -- <br /> :�` Water Table Depth = izeProp. ane <br /> .,_..�,. ^� FS <br /> > - <br /> _ oc <br /> /- unddt.ion_ ---- -- --------------� o L <br /> Dist`ance;to en ares#: Wein =- <br /> r --------- <br /> -------------- <br /> - <br /> ----- :Date ._. ._ <br /> REPAIR/ADDITION (Prev. Son itat.ion.Permit#. •-- -- <br /> E , ----------- <br /> ----------- ---- -- --- -- --- -- -- -- -- -- - <br /> j-- -- ' -- -- <br /> 7 <br /> Septic Tank {Specify Requirements----------------- �. > � ,�it. a-- -------------------- <br /> --------------- _- <br /> ; - �..- <br /> 7�� <br /> Disposal Field (Specify Req irements)------------- ---- ° <br /> ------------------- =--- -------- - <br /> i ------ <br /> - <br /> 1 --------- <br /> 1 k„I,. ; (Draw ezistingand_required addition on reverse side) I <br /> w ( lication'and that the work will�iiet:done in ciccordance with San,,Joaquin County <br /> I I hereby certify that 1 have prepared this app ' 1 '. <br /> Ordinances, State Laws: and Rules and Regulations of fibs San Joaquin Local Health District. Home owner or licensed agents <br /> . "_ <br /> I signature certifies the following: _ �` _ ; <br /> � � p erson in such manner as <br /> j "I certify that in the peiformdrice of'the :work for which this permit is4dsued, 1 shall not em loy any p y <br /> laws of California." <br /> to become sub, to Wo kman's .0 pensation ` <br /> 1 --- ' n <br /> - --... <br /> -Ow <br /> Signed : ... . . --------- -------- -- t <br /> t " ' ---- tle----- ----- . ------------ <br /> 1 BY----- ------------------------ ----- <br /> ----- ----------- -- -- <br /> - i <br /> (if other than owrierj <br /> { +.... <br /> - . TOR EPARTMENT ONLY• <br /> i DATE. <br /> APPLICATION ACCEPTED BY-------- <br /> DATE r <br /> --' -------- <br /> --- ---=---=--- <br /> DIVISION OF LAND NUMBER.-__---- -------------------------- •- ;-------------- <br /> -------------=-------- ------ <br /> ADDITIONAL COMMENTS--------------- = <br /> ----- ---------------- ---- --------- - --------------------- <br /> r ------------- <br /> ------------------ <br /> ----- ----- <br /> * -------------------- <br /> - --- ------ ------ -------- ------ --- Date ---- ---- - <br /> SAN JOAQUIN LOCAL Final Inspection b — rxs s R aha 3M <br /> p Y� � L HEALTH DISTRICT � - <br /> EH 13 24 <br />