Laserfiche WebLink
rj 0 <br /> t�,olnp�ara rro �npucarar <br /> ...................................................... 7 <br /> ' Date Issued___ 7744_____________ <br /> __ _,•............................................ This Permit Expires 1 Year From bate Issued <br /> Iripplic0tion is hereby made to the San Joaquin Local Health District for a permit,to construct and install the work herein describe <br /> c his application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> 467- 1 l'v /cam ................:..-- <br /> ..........CENSUS.TRACT..---_-----•--------------- <br /> 0$ ADDRESS/LOCATION.•.--.-... - --11-----Q-7....... <br /> -------f�-----a-f_-r- -- -----9q. r� <br /> C.9 -RAT �L iv/vsnrfr� ....:--- . . ................ ........ <br /> hniner's Name_...._ - -- -- - - - - --•---•�--- ----; ---- ..._ --- <br /> IV14l !:.. zip <br /> F,ontractor s Name----.---A.Wit:A _. u Zed • • ---License #. P one__ -32'� __. <br /> ,istallation will, serve: Residence 21 Apartment House❑ Commercial p Trailer Court ❑ i <br /> Motel ❑ Other----------------------------------------- - <br /> lumber of living units:._/_.._..__..._Number of bedrooGarbage Grinder Lot Size------ -••-•--•----- -----•----- <br /> i <br /> dater Supply: liublic Systim and name.................. --------------------------------------:--------_----------- --- -- .....__....._.. Private <br /> haracter of soil to a depth of 3 feet: Sand[I Silt❑ Clay Ig Peat❑ Sandy Loam ❑ Clay Loom C] <br /> Hardpan ❑ Adobe❑ Fill Material------------If yes,type-------------------------------- <br /> F 1ot <br /> .-•-___•_______________________F1ot plan, shoving size of lot, location of system in relation to wells, buildings,etc. must be placed on re4erse side.) <br /> IEW INSTALLATION: (No septic tank or seepage pit permitted if publi6sewer is available within 20( feet) _ <br /> ACKAGE TR MEN <br /> T ( J SEPTIC TANK (.) Size.., -G %?• ..................Liqui Depth_.-t��_-__-.__-_--.. <br /> p �� <br /> Capacity-A TYPe!_� _4� ?!.Material_........------••-------._No. Compartments. `?Z,. - <br /> �i Distance to nearest: �Well -----------------------------.Foundation. :� `o=--- --•----••---•----PrP• Line...d.7.�._:___•____._- <br /> EACHING LIAJEJ [ ] No, of Lines.______________________length of each*Iine..__�r ...................Total Length..L./!;?P.,.................. <br /> j � <br /> ` D' Box.., :_.,__Type Filter Material, XA. Depth Filter Material.__/ �l__.___' <br /> Distance;to nearest:Wel!:4,/,,�7..............:_.Foundation....................._......Property L{ne...6.'Z-----------_--------- <br /> t ! . <br /> EEPAGE PIT ;} --- bepth, l _._._-Diameter �_..t%_._:.Number...............•___.:..-__--___- R k Filled Yes o <br /> •,,aa , . <br /> Water Table Depth T' - .......................Rock Size..... - <br /> P ,-•: -s ------T- <br /> 1 <br /> Distance to nearest:We i.__. _.--- Foundation__________________________Pr�ip. Line._..__..:.__•__-____ <br /> •.EPAiR/ADDITION (Prev. Sanitation Permit#-- ----= :----:-•----:-------------•- Date-_----------•---•-------•---------------;-----) <br /> eptic Tank (Specify Requirements)............... i= j-- - _ --......................... - <br /> {� <br /> Disposal Field { pecify Requirements]....:. ----••-----• .... ........-•-----•-----•--...---•--•---------------------------•-- ._l._......_._._. - <br /> �_ ,ys. <br /> 1 i <br /> 1....................................-------__-_-__.______-__-_-__r-_____-_________._ ----------------------------------- <br /> ---­--------­ <br /> ------------------------- <br /> .__._..___._____._______.________ <br /> - r <br /> _ '..__..�._.._ _ ...................._______________ <br /> (Draw.ex(sting an equired addition on reverse side) <br /> % <br /> hereby certify that I have prepared this a ,plication an that the work will be done in accordance with San Joaquin,Coin <br /> )rdinances, State Laws, and Rules•J ants-'Regulp#9,ns.,_of the San Joaquin Local Health District, Home �wner or licensed age <br /> �ignature certific!s the following: -_ <br /> I certify that iA the performarice�of the work for.whlch t is permit is issued, I shall not employ any person in such manner <br /> o become subject to or an i Co pensction--laW`-of California." <br /> igraed....... t . ,_:_:_ Crwner. <br /> �. ------.•-•Title.............----••......-- <br /> sy..................... t ---.-._... <br /> {If other than owner) <br /> Fi FORDEPARTMENT USE ONLY <br /> f <br /> APPLICATION ACCEPTED BY `. ------------------------•------_...:..---------------- DATE:.:,7+.��-=�,7 - <br /> NVISION OF LAID NUMBER. ::- �: _ . .:-.:--._..-,,,_....... �..__......__,.w_....._.__..___:�. <br /> WDITIONALCOMMENTS_--•---••-----_----•--- ----------•----------------------------•----__...-_-___---.•------------------------------------------------------------------------- <br /> -- - _._..:�.w =;t 15�;= .. %1'�----------------------- <br /> F. .... ......................... --------- _page _ l! Y-. <br /> incl Inspection by �z r - <br /> H;i�3� :.. .. ,. i .SAN::Jt7�1QLlINLOCAL HEAl,7tt DISTRi�t r,: <br /> 3.21677-RE <br /> v '7 <br /> F <br />