Laserfiche WebLink
FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ------------- -- ----------------- <br /> (Complete in Triplicate) Permit No: Z"_6_.i___. <br />_ _________________________________-_____________- This Permit Expires 1 Year From Date Issued <br /> Rate issued <br /> Application is hereby made to the`Son Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This application is mad(e in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION _--4.59-----F------MOOD_V—6-RD-------------------------CENSUS TRACT _-S T_ -- ------ <br /> d Y- ' <br /> Owner's Name ��_ /_� f} - ---------=----------------------------------------------Phone ,____-- ---------------- <br /> Address ------- S ------ _�-------W�_ l�}RD----)........ City _-MAN ac ''rte <br /> . . •---..... <br /> Contractor's Name __-0.Vf ----------_ --------License # ------------r::--Pone ------------------------------ <br /> Installation will serve: Residence e_;(Ipartment House,❑ Commercial ❑Trailer Court;❑ <br /> Motel ❑Other ------------------------- ------- - <br /> g l 9e'Grinder .. 5 Lot Size -- <br /> Watebr Supply:fIv,PubliclS •stem and Hamer of bedrooms _- Garb � , <br /> a <br /> - Y ; J F - -------------------------------- ------------------------------------------------Private <br /> �� <br /> Character of soil to a depth of 3 feet: ' Sand'❑ •Silt 9�Clpy E1__LPeat:- --v-Sandy. Loam 12r--,Clay-Loam ❑ <br /> '21HardpanF❑ Adobe ❑ Fill Material _ _ __ If yes, type ---------------------------- <br /> (Plot <br /> ___ _______(Plot plan, showing size of lot, location of sys4m in relation to wells,.buildings, etc. must be placed on reverse side.) (� <br /> NEW INSTALLATION: (No septic.tank or seepa! pit permitted ' i lic sewer is available within 200 feet,) le <br /> PACKAGE TREATMENT [ ] SEPTIC TANK' Size__ ___X__1_ ____x___-__ __ -_- `_'Liquid-..Depfih _-J ____________ <br /> f Capacity _ __ .,_ Typ`f.P--Re--IOS—T--MaterialM-IVC _� 7`-No. Compartments __ ------- <br />� LEACHING LINE �o, of Lines - -��YEengthr a `--Foundation i_1�__"�_____ Prop. Line __.-� ^"L <br /> stance to nearest: MelG-.__,� _ <br /> ' 4 � ____ Total Length-__ fa' <br /> # each line-__-_ ___ <br /> I p cf t Ir <br /> 'D' Box/y6-5- Type: Filter Material &C-� --Depth Filter Material __-_�_ _ ________________ <br /> istance tone -est: Weli ____•7�_ ^Foundation -----10i.....7t= Property Line ----- "4— <br /> SEEPAGE PET Depth -_ f ___ Diam"•`6�ter- X_ ___ Number ------------------`--------- Rock Filled Yes No i❑ <br /> Water Tai le_De t _ __�______--------------- _____Rock Size �I r----- <br /> Distance <br /> r i ` <br /> i \ r <br /> Distanceto�_n"rest: Well - 1� ----}-�ti-- Found ion i-�Ll._-----•--- Prop. Liner--- `_------• <br /> REPAIR/ADDITION(Prev.'Sanitatidn`P.ermit# <br /> e <br /> a-- _____________ Date ----------------------------------) <br /> . <br /> Septic <br /> i ►1t�,:� <br /> Tank (Specify Requirements)j- - -- ---------------JN--------------------------------------------------------------1"i. ----•----' -- �"- --------- <br /> Disposal Field (Specify Regdirements) _-- - -------------------------- <br /> is--------------- <br /> E- <br /> (Dra%,Vj'existingand required addition on reverse side) <br /> I hereby certify that I Have prepared this-application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, State1;Laws, and�;Rules,and Regulations.o�f the San Joaquin Local;Health District. Home owner or licen- <br /> sed agents signature certifies the following f Kir 1 certify the Performa ce f the work or whjch this miAs'issued, I shall not employ any person in such manner <br /> as to beco a ubject to Work 's�Co a tion.la`rv5 of California." <br /> Signed ------ -- -------- ---- _ � w,ner <br /> ------- ----------------------------- <br /> Y - - ------ -------- A --f�-- It, -=,-=-------------------- ----- <br /> (If other than owner)'{ i <br /> ; FOR DEPARTMENT'USE ONII , <br /> -- '?1- -----. DATE S --- f <br /> APPLICATION ACCEPTED BY : `` REQ r- `� y - <br /> BUILDING PERMIT ISSUED ------e"` ----------------- -------------------------------------------------------------------------DATE ------------------------------ <br /> ADDITIONAL COMMENTS=--.26------- r'-� - <br /> — ------- <br /> ­- ------------------ - -- - - ---- - --------- ----------------------------------------------------------- <br /> - - <br /> ------------- -------------------- -- - / <br /> - - ---- - ---------- -- ---------- ----- <br /> Final Inspec -- ------------- ---- -- - - --- ---- ------ ---- ---------------------Date -- -- <br /> SAN JOAQUIN LOCAL HEALTH- DISTRICT <br /> y ' <br /> E. H. 9 1-'68 Rev. 5M �, <br />