SU0006324 - Laserfiche WebLink

Home Browse Search

S FOR OFFICE USE: 7/0 Id/N /"' FOR OFFICE USE: p► UCATION�.FOR SANITATION PERMIT t --------------------------- -------------------- - Permit No._.77 ----------- -------------------- (Complete in Triplicate ---------------- Date Issued X14-- 77 -------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for permit to construct and install the work herein described. This application is made in compliance wUlm- ith County Ordinance No. 549 and existingi s a g u JOS ADDKESS/LOCATION-- --.> -�go-�' - j/ �A�•+ r 7 E t]S TR CT ' { Owner's Name- _.;8. rJ'/ :. P n� `` ho ' #/ Address �1 �P -----'S9 ./�j� 1 _,l�i - CrtY �G/ ------�--- --------Zip ------------------------- --------- Contractor's Name------IV ---- �'�------ rcense #--t .�7�7 - Phone. / G! Installation`will serve: Residence [r�]� AVZOL partrrlent House ❑ Commercial ❑ Trailer Court ❑ . Motel.-El Other - --_ -' --- ---- Number of.living.units:.� ----.Number of bedrogms - ' -...Garbage Grinder-.A0.-Lot,Size...... ..... .. .== Water Supply: Public System.and name_....... - S L ; y Prry - - ate! 1 Character of soil to a depth of 3 feet: Sand Slit❑ Clay ❑ Peat❑ andy Loam Q a Loam[ 4 _ F. Hardpan ❑ Ac3o e; Fill Materra.l------------1f yes, type x bu ldings,.etc.must be placed-on reverse side.). . (Plot plan, show ng-Arze of lot, location of system in relation to wells, ., P NEW INSTALLA&ti (Noy se tic tank or seepage pit permitte�u c s we}�is, il�able within 200 feet,} - _Liquid -------------- PACKAGE TREATMENT �[.] SEPTIC TANK'-[-';'-] Size---- --- �- -f---�- -- ,.qu..- Depth �/ Ca dcit -=Typegx Material � 3-1"=iso- mpartmen#s - P Y= .-Distance-to.nearest: Well .____- -- - g Foundation . --_--Prop. Line'_. � �D --- - Len- t. of each line Leng No.-af Lines.;. s g - .Total LEACHING LINE tb I.-1, �"` . °. ;. 'D' Box Type Filter Materrall. ' / De th Filter terial f �. .. c ; - :Distance to nearest:Well _-Foundation Property Lr I _ N SEEPAGE Ply [T 1 Depfki Diameter Number ------------------------- R oek Fit ed :Yes..❑ o,[ 1Nater Table Depth ----- --- _'_-Roc k Size ' - -Foundation Prep L e - Iistance,to-nearest::Wel1 - in f , ..._ REPAIR/ADDITION (Pre* �ariitatron-Permit#_ Date Lf JJ / Septic Tank (Specify Requirementsl..._.: �� ' / ..--- Septic' Disposal Field{Specify.Requirementsl- ----- - - ------ -- ----- -- - _-...r.....---- - (Drew exulting and-required addition°on reverse side} I hereby certify that l have prepared this:cppliCation ulnd that the`work will be 'done--in accordance with San Joaquin CouRity Ordinances,' State Laws; and Rules.and Regulations 6fF t to Sari Joaquin Local Health Districf Hattie owner or licensed.agents. sigr+ature certifies the following: "{ certify chef ittE the performance of.the work foe which :this permit is issued, I shall not er*+ploy any person in such,manner:as to become .'subiect to Workman's Compensation laws of .California.". Signed -- --- -- - --- -------:-- . _ n -- ------ Title- B :. € } (If other-than owner) h4 v _ EPARTMENT USE ONLY. - - ----------- -- DATE l ----------------------- -- APPLICATION ACCEPTED BY:?---- - 7 ---- -- -- ----------------- E D A DIVISION OF LAND NUMBER -- _ ----- --- - --- ----" �rrt- �j _ ADDITION OM : NTS _G!��-l��f� - ----- ��p�'---- - . �: .. --- -- -: --------------------- --------- :::: --- _ --------•------ ---- ---- - - - ----- --- ------ - -. - -- Date e ' 7? ' Final Inspection b " P y'" "'-''--" F&S 21677 REV. 7/76 3M EN 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT