SITE HISTORY - Laserfiche WebLink

Home Browse Search

F;V. OFFICE USE: FOR OFFICE USE: • APPLICATION FOR SANITATION PERMIT • ---------- c, ..- ---- -- -- - ------------- - Permit No._ r�.�.�-Al ' --------�-- - (Complete in Triplicate) Date Issued..-_!-_V-F ............ ....... ----------_.................. ..... This Permit Expires 1 Year From Date Issued Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliancewith County Ordinance No. 549 and existing Rules and Regulations: .. .. JOB ADDRESS/LOCATION...... 570°/.3- � C {�jJVCS _--�- y„CENSUS TRACT_ ............. Owner's Name.- --..-... ........ ...........G7.. -G .} . . _ ----- -- ...._...- --- -- - --------------------------------- .Phone-.......... � Addresi----- ..._.... . � ---- -_........................................... ty.;...:�5_e-A4QN.. -- --...Zip. .....- - Contralor's Name.--.....•E...- ./l/.7. .(� I ------------ --------- -------------_------- . ..-• - - - .. .-•------ ---•-------•--------...License yo"�/ ar . �. I Installationwill serve: Residence Apartment House❑ Comm rcial ❑ Trailer Court ❑ Motel ❑ Other----- -- - ----- - --/� Number of�iving units:._..t.........Number of bedrooms-3..-..Garbage Grinder............Lot Size. ......p ... Water uppiy: Public System and name------_--- _...... . ....... .... . -....... ..... ............. --- ---------.................... -------.Private Character of soil to a depth of 3 feet: Sand E] Silt❑ Clay [:1Peat❑ Sandy Loam C] Clay Loam ❑ Hardpan a Adobe❑ Fill Material............If yes, type...--_----------------- ------ (Plot pltln, showing size of lot, location of system in relation to wells, buildings, etc.must be placed on reverse side.) NEW IIIISTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) I PACKAGE T EATMENT [ ) SEPTIC TANK [ ] Size......_....................... ...... ....................Liquid Depth..-..----_---._.-------� Capacity--------......--Type_---_-_----- -Material.--------.....---......No. Compartments......... ....-------------------6 Distance to nearest: Well.a--------.- ..-. --. Foundation...._........_....--_..Prop. Line.�..........................0 LEACHING LINE [ I No. of Lines...........................4..Length of each line...............................Total Length .............. ................. 'D' Box......--....Type Filter Material........--_-_-- Depth Filter Material........... ......_-...........C Distanceto nearest: Well.........r Foundation........ -........._.......Property Line...... ..._................-------- _1 --.-... _ SEEPAGE (I PIT [ ] Depth................Diameter....--_..... ......Number........---....-_._--_-_--- Rock Filled Yes ❑ No❑ Water Table Depth------- ----------.......... ........___.......-..Rock Size--__----_-_----.......................- � C � r—^-.DistorrceYo nearest: Well...-.------.-..- .......................Foundation....--------------.......Prop. Line__._-------------- l _a REPAIR,[ADpITIQN (Prev. $anitation Permit#...............�.:..... "�`..........:. .'-D-ate..-.-..-.-^.'^^""'^"....'-- Septic Tank'(Spdcify Requirements)Ji .-...� rti-- - - �y. -- . .... ....--- .......=............. ............... ............- -t -.. Dis osal Field [Specify Requiretents]I c - - ------------------------------- ..........; 1 ---- ------------ ------------------.. .. L.Z -J ��--- Q�. ?�.��C� _ L ---_--------------- --------------------- --_-- --...._--- .....I �........ - - ! :.� -....4 i ,.. - ------------- ;- --------- ---- ---- --- r - _ t l ` ' ( (Draw exi0ing an �eqv[eda�t tJit[on on reverses e I hereby certify that I have prepared This applic tion aa'd-$iat the work will be done -in atc with,$an Joaquin County Ordinances, State Laws,and Ru}and Regulctibns of r1i,e San Joaquin'Co2al�Mealth Witrict-Momb owner or licensed agents signafure�certifies the following:N,7 y I ` '` f �" j.'� i`` 'I "I certif tho"' t in the performanceCof .the work for wl �, fs if is issued, 1 shall not e`rmplgy any person iri"such manner as to beco `suuobject to -'m n s11; Compensation laws of•Cdrfo.mia:" _�"•� i � Y y v Signed. --L/ -------- - ... _ i................. ...... ... .. Owner ..------ -]`--L. ....... -..�.. .... ,-t.................._,... r ...Title.-- �`.. 1.3 - ------------- By (If other th owner) , t — R ORr. PA MENT USE ONLY APPLICATION ACCEPTED BY... DATES- � .. 8 DIVISION OF LAND NUMBER............... ... - ..� - ............... ....................................DATE_........... . ADDITIONAL COMMENTS.------------------------------------------------- ....................................... ................ .... ...... - ............... . ... ..... ----- .................... ...................... ................ --- - -.....--- ................ -------------- Final Inspection u by: - - - - -----------------------------Date.- -�-�--------y------ ---- ---------- er 13 SAN JOAQUIN L HEALTH DISTRICT F6 REV.]/]6 3M