Laserfiche WebLink
FOR OFFICE USE: FOR OFFICE USE- <br /> AY APPLICATION FOR SANITATION PERMIT <br /> vp <br /> - .............__...-.... _ -. No.7 _:.�C/�'/ <br /> (Complete in Triplicate)te) �--� <br /> Date Issued.J/r.-50:'� J' <br /> ----.-­- --- --- ---- This Permit Expires 1 Year From Date Issued <br /> tt. <br /> application is hereby made to.the Sar, Joaquin Local Health District for a permit to construct and install the work herein described. <br /> -s application is made in compliance with County rdinance No. 549 and exist g Rules and Regulations: <br /> y� /a � 'y� u� <br /> !OB ADDRESS/LOCATION...-.- _. 7- - CENSUS TRACT............... <br /> - .. <br /> ?vner's Name... �t-�?'°,. y'W.71�.??�-f� /--- - -- ..... ------- -- .. Phone-----.. <br /> .... ._.. <br /> _-Z'p _- <br /> ------ .----- <br /> - <br /> dress- -. <br /> Contractor's Name - - --------- License #_3(/✓�Cpp.__Q//.-._Phone_ f_-6..j_- _lK--- <br /> �taliation will serve: Residence ❑ Apartment House ❑ Commercial Trail r Court ❑ <br /> Motel ❑ Other._-.. ._----____------ ---- --.. <br /> }lumber of living units:..-_._-----__Number of bedrooms----.---__.-Garbage Grinder.._._--.--.Lot ize_-_-.. c./.a.. /....11k,,....��� <br /> ��ter Supply: Public System and name-.._....._--._.__--_ ..._.._..._----- -_-_..._..__-__--.____._Private ? <br /> character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay❑ Peat❑ Sandy Loam ❑ . Clay Loam ❑ - <br /> ` Hardpan p Adobe Fill Material.- ._. ....If yes,type____ __ ___ <br /> _ _ -_---- -.- <br /> P1 t plan, showing size of lot, location of irystem in relation to wells, buildings, etc. must be placed on reverse side.) A_ <br /> JEW INSTALI.ATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> CKAGE TREATMENT f ) SEPTIC TANK /�t -------------._._..._- - _.Liquid Depth._.:7�-__-__ _O <br /> ..CKAGE — <br /> _ Capacity./62(00__-Type -_.._-:No. Compartments---------.-__r�=...._.... <br /> . <br /> - Distance to nearest: Well. -------- _---------------Foundation..._. _..._ - .._.Prop. Line--- _/ <br /> ` / r r <br /> '+ACHING LINE p� No. of Lines .-/----------------- <br /> ..._._-------------Length o ch lina.,/CW _.._._. _. Total Length _ ./ ,_0_..a....----- ------ <br /> .rr <br /> D' Box... ......_Type Filter Maferiaas_ . -d:-C/C.Depih Filter Material...___, ----------------------- ..._._... <br /> Distance to nearest: Well---- �_..�---------------.Foundation....j5._---------------Property Line...__.�----------- .- ---------- <br /> Ni <br /> SEEPAGE PIT [ ] Depth........_. ..- -Diameter........_ ...._---Number_._------ ..___.__....._.__- Rock Filled Yes ❑ No[k, <br /> Water Table Depth--- ---- ----_............ Rock Size.. ......_..-..___--- ------------...-- <br /> �" Distance to nearest: Well__------------------.------- ----------.Foundation...._-'-._-._-----._Prop. Line.------------_-_.'. <br /> tEPAIR/ADDITION (Prev. Sanitation Permit#-------------------- --__. ...... ...............Date--------------------_-------._-__--- -----] <br /> 3tic Tank (Specify Requirements)..__...- -------- -------------------- ------------------------ -_- -------._.-----. <br /> r <br /> Disposal Field (Specify Requirements) ._....: - - ------------- <br /> . <br /> . --..._.. <br /> ----- ...-------...---------------------------------------------------._....-----'------------ -- -- - <br /> ......................_..__--------- <br /> [Draw existing and required addition on reverse side) <br /> ,ereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> 6.dinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licensed agents <br /> signature certifies the following: <br /> certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as <br /> iw bec and a ,sub'�}' cct�t/'10�J� War n's Camensatiors <br /> tilaws of California." <br /> iigned-- ISJ -..'.. (r b / /.. ........... Owner <br /> -----------/----- --- - ----- i , 4 ._......-Title........... <br /> ` (If o er than owner) <br /> FOR DEPARTMENT USE ONLY y <br /> iPPLICATION ACCEPTED BY-.---____.__. � - . -. .- ...-.--------.------_.DATE .-J.� _-3.0. .7.6.___.-----___--- <br /> DIVISION OF LAND NUMBER- - ---- -- -- - --__.... --.__-- .. _.......DATE----- ----- <br /> .---............ . <br /> -DDITIONAL COMMENTS. --- -- --- --- - ---- ... .._ <br /> ............................ - - <br /> nal Inspection by:. ..- _ ..-- --- ...- - - ---- ----- Date_J- .q_ 219---- --- . ... ..-- <br /> Em 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT ras 21wr REV.7/76 sM <br />