Laserfiche WebLink
FOR OFFICE USE: P 1rc e FOR OFFICE USE: <br /> APRL[.CATi6`N'FOR'SANITATICN PERMIT. <br /> v <br /> �` (Complete in Triplicate) ` Permit No...7.. <br /> ...............1.1p.....................'----. s �/5 » <br /> d Date Issued.................... £ <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 compliance with County Ordinance No.549 and existing Rules and Regulations: il+ <br /> — T . - ._.....ri .... ..... ._ <br /> t JOB ADDRESS/.LOCATIOh1; L3�- - - - - +`- ------4-CENSUS TRACT... - ..... <br /> t <br /> Owner's aN,aaeyyme -------_?J -:- ---- -------- ---- -- --------------- j-: ... ---- .....Phone%_....: - <br /> ' f - - CltI S-B dam---- ---------------...Zip <br /> Contractor's Name..: . ..- --`:--- ------.------'----.._-.-----------------_-.i.__._-'-.-_license #.�7 _sir `1'.....Phone__!S S_.T ...... <br /> Installs+ion will serve: Residence❑9 Apartment Hogse.M Commercial V Trailer Court ❑ <br /> d. . . . ;. . , . : Motel' LOtlie :--`-_.......:..i..:.::±:.------.::-'-- <br /> / 7 <br /> .. - - d"� ...:--•--!_......-••.................Slze.k�Ot. :.Q'G'Z;.��..a..:�................�, <br /> Number of living.units:..............*umber of bedrooms.".. -••-•Garbgge Grinderw.: .•.:-Lots •' -C...' Pflvate q$'Y <br /> Water Supply:Public System and name...,,,.­. <br /> ' Character of soil To a depth of 3 feet: Sand ❑ Silt❑ Clay❑ , Peat❑ Sandy Loom❑ :Clay Loam, <br /> Hardpan ❑ Adobe❑ FBI Materigl............lf ye$,type...:, <br /> ' (Plot plan, showing size of lot, 16 r of-system in relation to wells, bUildlrrgs,.etc.must be placed on reverse side.) <br /> NEW INSTALLATION: .(No;septic tank or seepage'pit.permiit�tt-��eydd,,.IIT public sewer is avallable within 200 feet,) , <br /> PACKAGE TREATMENT [ ]' . SEPTIC TANK. <br /> .... . . size .. i <br /> A.....E..........Liquid Depth.....$...'. <br /> .......... <br /> CapQcty/a3.Q r;'Type CorpaTmeTs.....AVM �?Z.....*. <br /> DistanrdtoLine <br /> s� <br /> neorru/, Weil.,�Q..Q.Q. .: .. .:.....:.. ,z1Foundaticn....�41 .........Prop. Line...6. <br /> LEACHING LINE. No. of uines.i.,_,,. C;. ....:. (..length of each line.,r ,., ,,.,,„. :.Total Length.;... lQ.:::......:.................. <br /> �j /d <br /> D' Box'; Type Filter"lbterialSrl?Qfk..Depth Filter Material....,r:4.......... ......:......... ..... ` <br /> Q Distance,to nearest:Well �Q�Q....:.t...Foundation....&r...............Property Une..j;F_. ......._*tW..... . <br /> SEEPAGE PIT [� Depth.. .;....Diameter'.......:...........Number...;........................__.. r rRock Fill Yes V' No <br /> Water Table Depth_.:..c?.Q__;................................... <br /> _.._ __....._.... _..Rock Size....ar?._l n3.. <br /> i Distance to nearest:Well..: O.d _ ...,.t........._Fou ndation:.:,9...6J..............prop. Line.._.. ........... <br /> ' REPAIR/ADDITION (Prev.Sanitation Permit#. .......:......:::... : ''....:Date.............._...:.......................... <br /> ) <br /> Septic Tank(Specify Requirements) .......... --' '°=`----------- .........._...................................................................... <br /> ....._.. <br /> Disposal Field,[Specify Requirements).... ......--...................................... ......1 ------------------------------ <br /> - ------------`---------.....- -----........1...........:........ <br /> ,..I <br /> - -:. ....... :.::..........:.............:.................... .::...-:: -- - -- ...... ------......--------------- - <br /> -----............:.........................--... ......... :.,..... `- - ----------- - --- <br /> ---- - ---------------------....__...._.......----------------------------------------------------- <br /> -� <br /> I " (Drow'existirig and required addition on reverse side) <br /> 1 I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County t <br /> Ordinances,. State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licensed agents 1; <br /> ' signature certifies the following:; ter. lI, <br /> "I certify that in the performance of the workr:fowhich this permit is Issued, 1 shall not employ any person in such manner as <br /> I* beco bj f Torkm <br /> --- -- 'sCempensafion ,laws of California." .. _. <br /> Signed----- --- ---------- --- ---- - - <br /> ..•... _ - _ _.Owner <br /> By---------:-------- .c�`f...GL/_ ----- ........-.---J'itle .S!�"7/..:- <br /> ' t <br /> (If othei an ,ownet) 1 4 <br /> ,FOR DEPARTMENT USE ONLY' I <br /> ' APPLICATION ACCEPTED BY.. ............. . .... : `a........:...:.........:.......................... <br /> DATE.✓` �� ....�I. ...__.....'S.i... <br /> DIVISIONOF LAND NUMBER..-- a...................... :.;.;............................,............ ........................DATE-------------------_.........:............... <br /> ' ADDITIONAL COMMENTS.. . ...a..............................-------------•------------------- •--------- --- - :_------------ -.......-..... .----.........� - <br /> -- <br /> ..................................... ---­------- <br /> fi�rr''•• ] <br /> rt" Dater d..__� / ..._ <br /> ' Final I•nspeehon by:--= - _:.. -=--- ----- --`----' -- ---------------`.................------- - �...........:.'---- <br /> Ex 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT rss 21677 REV.7/76 sM^' <br />