Laserfiche WebLink
FOR OFFICE USE: .j APPLICATION FOR SANITATION PERMIT FOR OFFICE USt: <br /> ....................................--- - _ _ <br /> VVV <br /> • - [Complete in Triplicate) Permit No.... <br /> - <br /> -•----• -------•----------------------- -------- Issued..1 a'� r7Y <br /> Date ................:. <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- <br /> "7 C7��72td 17E - - ---- -----..CENSUS TRACT------ ----------- -- <br /> JOB ADDRESS/LOCATION............... ..-._._......-_-_-.---. <br /> Owner's Name...- .-. �� GCJ/g/i7L> Phone--- X66 --0SSS <br /> ---- ----- ------ - <br /> Address-.-- <br /> ....e . L9��Ti�/DE------- - - ------------------------ Cit s -Gk�,p........ ......Zi <br /> Y P <br /> F <br /> Contractors Name....r�: 4fS/I. S ----.---•-------- Licensea o63 �7 <br /> .. <br /> Installation will serve` Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ <br /> Motel ❑ Other------- ---- --------..----------------- - --- <br /> Number of living units------- --------Number of bedrooms.. -3.. .Garbage Grinder............Lot Size--..-- 3-. . X. Il�_---.-.-------- <br /> Water Supply: Public System and name.- - .Private ❑ <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt ❑ Clay ❑ Peat ❑ Sandy Loom ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe'X Fill Material . ..- ....If yes, type ----------------- <br /> -- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) ..J <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT ( ] SEPTIC TANK ( ] Size ...... --------Liquid Depth.-----_-- - ------_ <br /> EXL�- TGAJ6, Capacity .. .................Type---...------- ......Material-- --- --- •--------No. Compartments.........•-............. ... <br /> Distance to nearest: Well............... ..... .. ........ .........Foundation.......... . .... - -- ...Prop, Line... --------- ...... <br /> . <br /> LEACHING LINE ( ] No. of Lines - ------------ ------.Length of each line--------------::__---- ... -Total Length <br /> EYI577A fi 'D' Box............Type Filter Material. --.. ,.., Depth Filter Material------------------- ----------•-•------ ------_---..-------� <br /> Distance to nearest: Well--------------------------Foundation----.-...----------------- -Property Line--------------------- ---.-.----. <br /> SEEPAGE PIT ( ] Depth---------- .----Diameter---------- ...-Number-------------------------------- Rock Filled Yes ❑ No ❑ <br /> 6�XIS.7-741Ei Water Table Depth--------------------------- --- ....... -----....-.Rock Size- ----------_---- -----------------.-- <br /> Distance to nearest: Well--------------- - ------------------'=Foundation................ . Prop. Line----- ...---------_------ <br /> REPAIR/ADDITION (Prev. Sanitation Permit#------- D-a-//-------- -- ----------- --Date----- "-/ 66--.-- --- ----------) <br /> SepticTank. (Specify Requirements)........ ...... ----- - -------------------_-- ------ --------------- ---- ----------- ---------------- --- ------------------------------------ <br /> Disposal <br /> .. -Dis osal Field JSpecify Requirements)---EN57FGL36-`,X n?Sy. <br /> .�, �PPs. <br /> r------------- - <br /> �lST2l.� U. _ N.. a�rE Sy -r-is---vA ... ------------- <br /> 7ZP (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work Will' .be done in ,accordance with San Joaquin County <br /> Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District, Home owner or licensed agents <br /> signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as <br /> to become subject to Workman's Compensation laws of California." <br /> Signed.-- ._... -.... ....... <br /> BY------------- Owner <br /> r <br /> - Title... S-�-.. <br /> (If other than owner) <br /> F R D ARTMEN LIS ON <br /> APPLICATION ACCEPTED BY---------- ------ -DATE .-- ---- - -- ---- <br /> DIVISION OF LAND NUMBER................... ... .. ----fv F--- ------DATE....- ----- - --- - ----------- <br /> APPLICATION <br /> - ------ - <br /> ADDITIONAL COMMENTSL d r� _ ...... <br /> . ..-- -f Z 37Sf--. <br /> -•----•--•--------------------------- -- - ---- ---------- -------------------------------------------------------- <br /> ------------------ -- - <br /> Final Inspection bY:---- ..___`. ------------------ <br /> .41 <br /> - .Ti .-�. -...-.- <br /> F&S 21677 REV, 7/76 3M <br /> EH 13 24 + SAN JOAQUIN LOCAL HEALTH DISTRICT <br />