Laserfiche WebLink
_ R OFFICE USE: APPLICATION FOR SANITATION PERMIT FOR OFFICE USE: <br /> Kompletedn T,rlplicafol Permit No._7..__._._......_ <br /> G V3 ^aVV , t " 9� <br /> Date issued.......'.3-_?,7 1 <br /> This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in co apce ith County Ordinance No.549 and existing Rules and Regulations: , <br /> JOB ADDRESS/LOCATION....... 14�civ.._.� L „e2.�H...� ......CENSUS TRACT. ............ <br /> Owner's Name......­ ..... ..... ---------....... -- - --------L.,- -- - ..._..........._.Phone. -......-_...,-----...................... <br /> Address............... ., - .:........................---------- ........ ..F------ -------city........_........................... ... Zip ..... - ... --------- <br /> Contractor's Name....... ------- .......... .......License #�E. . .✓S+E,----Phone..5 <br /> Installation will serve: Residence ®' Apartment House[] Commercial ❑ Trailer Court ❑ <br /> Motel ❑- Other................. ..:.... Wi <br /> Numberoflivirsp.nits:....._.)........Number..of.bedrooms...Y;_..GarbageGrinder...__..__-.Lot.Size.........s..��c'ycs _ :_ <br /> Water Supply: FAIR:System and name. _. ... _ t...... ......:. .— _Private <br /> Character of soil to a depth of 3 feet: ; Sand ❑, Silt❑ Clay ❑ Peat E] tandndy Loa,m 2 Clay Loam ® i <br /> Hardpan eoA bd ❑ Fill Material.....,.....If yes, type...:......--------- .. .......... t <br /> i <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: 1No septic tank"or seepage pit permitted 43UlNii'igwer is available within 200 feet,) <br /> , <br /> PACKAGE TREATMENT (i1 SEPTICTANKlj 1 Size_--......_..___------__-_..._._.._._..........:.....Liquid Depth......_.._._........ --� <br /> I <br /> Cppocity../4 GPjf �. ------No, Compartments-,--A.....------------------ ' <br /> Distance to nearest: Well-:..N,_.. .................. Foundation.._. ......Prop. Line...._...... <br /> I 1 No. •of Lines..........y..............Length of each ......Total. Length._._/� ;:. . . <br /> \ r i <br /> Box...-3._...Type Filter Material_.._ ...Depth Filter Mater:aL._._.XL'....................._._..........._.__....:.... <br /> .:. <br /> Distance to nearest: Wefl.'_-_...._....._._.._....Foundation....'.._._....__.____._.....Property Line.........._................_. ....N <br /> SEEPAGE !T { ] Depth... ..Deateler.. .: 8 .Number_ti:~�. ._.� .,........ Rock Filled Yes No❑ <br /> 'I Water Table,Depth--- i-----------------------------.�."�'-R.. ick Size"...........------------------------------------ <br /> - O <br /> i <br /> Distance to nearest:Well:...........................................FoundBfior�..:... n - Prop- Line.......................... <br /> REPAIR/ADDITION (Prev. Sanitation Permit#.............:..........__..:..:.....:..._....:.::Date........:.__------...-----___.._......) <br /> Septic Tank )Specify Requirements)..... .... ..... - '- . �`— -s+ „Za w—...... .. - -------------------- -' - '- - - <br /> i `.. ''.. R.. <br /> Disposal Field (Specify Requirements);..._..............-' ------------..t. �...-------•--------------------------------1-`-------�- ----------......------- -...... ,.... <br /> .................. -------- <br /> I <br /> (Draw existing and iequired addition on reverse side) '4 <br /> I hdroby codify that I have prepared this application and that the work will be done.in accordance with San Joaq in County <br /> Ordinances;'Stdte'CGw's, and::RuMs'and�Regulalians�of�,-.the San Joaquin Local Health District. Home owner or•licerrs�ed agents <br /> signature certifies the following: i i j t 7 <br /> -"I certify that in the performance of the"work for wlhlih'A tis permit is issued, I sholl not ernploy-Wn`y person in such manner as <br /> ors C <br /> to become subject to Workman's lawsl6fi California." y st <br /> l <br /> Signed.--- . . ....��.Cdl 5&.4y : - - ..-._Owner <br /> ............... <br /> a ' ..... . . ..... ...--...Titl]e` -------By.. i. <br /> ........ - <br /> owrier) FOR DEPARTMENT'USE-ONLY - . .. <br /> i <br /> I . ...-_r 6��� <br /> APPLICATION ACCEPTED BY.__.... . : : <br /> .. .........::.... .. .................. <br /> t <br /> DIVISION OF LAND NUMBER_........ . ........... - - e c't .'-- .C---- -------..—DATE----DATE_..... --------- <br /> .........1..1+7 -------........-------------: - <br /> ii DDITIONAL COMMENTS..." -- . .................... - ` --...... -----` s,� . e:`=-- �c.w.l ..s............................... ........ ... ..... <br /> i. Yw . 4Y•. <br /> .......................................................-......................'-`-____..........._.,._....-------------------------------------- ..._-----.._..............i.... <br /> ` F&S 27 V.7 J 3M <br /> .._ ��.._` .. .............. . . _ _ ....... <br /> Final Inspection by:....( f - ----------- `=...,::,__----------------''_..--Date..:7=... 7.... ...........EX 19 2b SA JOACIUIN LOCAL HEALTH DISTRICT en 6E / b <br />