Laserfiche WebLink
I FOR OFFICE USE: FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) Permit No.".1 _�:S-l!7_ <br /> -------•-------•--••------------------------••-- -------- <br /> •••••••••.................... .............. This Permit Expires 1 Year From Date Issued 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 applicatio is de in ka c with County Ordinance,N"49:w d existing Rules and Regulations: <br /> � �.5��'l off' � .. r�­-f� <br /> w <br /> 71' <br /> JOB ADDRESS/LOCATION. --.------ V-eS.�---- �._ _:.. 5!!tik�et• Uva' �U TRACT--.-tS�r -'_.� .-�� <br /> l ` I <br /> Owner's Name. . - _.....-:._. . ... ............ ------.-. Phone <br /> Address------- 0 to -----Cits,?C3,S...... <br /> i <br /> C #ors Name.... " -V .. .. ....p.�V.-'---- - k-L ---- ...... � 2 ° `t �_ .` [ <br /> _ License # �� Phone._... . <br /> Installation willsser e: Residence Apartment House es E] Commercial ❑ �Trai er Court ❑ <br /> :r Motel ❑ Other--- -- ------------- --------------------- -- ► <br /> 12-0 Numberof living units;.-..... .......Number of bedrorroms.._.- .Garbaje Gurindt�'_-RO..LotkSize---42 . ... .. ......_..... <br /> Water Supply: Public System and name--.-..._�:1Ql...................... f`-f ...................... ------------------ ❑ <br /> -•---------------- •---•--------------...- ---------Private <br /> Character of soil to a depth of 3 feet: I Sand ❑# Silt []!-Clay E •--Peat-2 1 Sandy Loam ❑ Clay Loam ❑ I I <br /> Hardpan❑ Adobe Fill Material--. If yes, type- . <br /> (Plot plan, showing size of lot, location of•system in relation to wells, buildings, etc,,must be placed on reverse side.) <br /> NEW INSTALLATION: (No 'septic tank or seepage pit, permitted if pdblic sewer is,a•vnilable within 200 feet,) <br /> PACKAGE TREATMENT C ] SEPTIC TANK`.[ ] Size.-. � 1C:_la:__._......_ -_Li uid De th--------- --- - 1,� <br /> i <br /> Capacity.4.00--.Type_190et.G4se-Mate-rial--. o. Compartments.-------------------------- <br /> Distance'to nearest:,Well_._.,._ <br /> • -f.U�----.---- - ---..._Foundation-•----. Prop. Line-----f Q_ ..............�� <br /> LEACHING LINE - '�. ... `t <br /> C ] No. of Lines.._,... .-_... ............Length of path line...--- .__ Total�Length _. .... ................. <br /> D' Box..-' .-_....Type Filter Material...9V.&&Depth Filter Material...---1.�_.-----........................................... <br /> Distance to nearest: Well_:_W0iV4?J----_Foundation--------�._5:.........Pro <br /> perty <br /> 3-3 <br /> t - � Line.._._ <br /> SEEPAGE PIT Depth...AS./JDiameter....�✓... - Number------ <br /> --.-..-- <br /> ❑��-_.--- _---- Rock Filled Yes . No <br /> Water Table Depth. BQf--------- ---------------------- 7 <br /> i Rack Size--.-- ... ... ------_-----------------------w <br /> _`. <br /> Distance to nearest: Well_......."QNVf................Foundation--..._--_......� ..7Prop, Line.... <br /> ... ... . ......... <br /> REPAIR/ADDITION (Prev. Sanitation Permit#--------------------------- � -...pate--.-----:------------------ ---.------------.-) <br /> Septic Tank (Specify Requirementsl..... ................... ---------------..... ..--- -- - --------- ------ .................... <br /> Disposal Field (Specify Requirements) ................. ---------------` ----------- .---------------:---. <br /> 9 <br /> i <br /> it-..._----• •-------- i .- -- <br /> _ _ <br /> {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 f San Joaquin Local Health District! Home owner or licensed agents <br /> signature certifies the following: yR _ <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----- - ------ ------- ---------- ............. <br /> (If other than owner) <br /> R D PARTME T LY <br /> APPLICATION ACCEPTED BY ------ - ---------- --•------------ ----- .DATE..--.... .. .. ------ <br /> DIVISION OF LAND NUMBER .:-- - <br /> = - DATE . <br /> ADDITIONALCOMMENTS------- ---- ------- -- ..-..-..---------------..._ ------............------....------------. ........... ..... <br /> ---------- ---- .................. ---- -----......------...------...--.....------------......---.-------- ------ ------------ ........... --------- ........-_.........---.. ............... <br /> ----------------------------------------- ----------- - - --- - - -----------------­.......--- ------------------------ <br /> -- - ...... ...--- <br /> ........ <br /> --------- ........ ------ <br /> • fig. . <br /> ---------- -- :-Final�lnspecnan b . __--------------- ---pati. <br /> .....`'�.- � <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&5 21677 REV. 7/76 3M <br />