Laserfiche WebLink
_ r <br /> Vn Vi I ILL UJL: / rVK Vrr K.0 VJL: <br /> ( %PPLICATION FOR SANITATION PERMIT �r <br /> .......................... ....... .... ........... . 4 i' V-' <br /> [J Permit <br /> (Complete in Triplicate) M/J <br /> 6f I <br /> z ............... ...�..-.......... .... ................. EP 2 6 1978 �1�` . . -3/-7ft <br /> e Issued.8'............. <br /> --"- - -- -- - This Permit Expires 1 Year From Date Issued <br /> pplication Is hereby made to the Son Joaquin Local Health District for a permit to cons ruf- ct an ins I wopierein described. <br /> his application is made in compliance with County Ordinance No. 549 and existing Rules and Regul Ions: l <br /> OB ADDRESS/LOCATION. .-.r�rj�( J/ - ,,,, -...• � .. . ......CENSUS TRACT i.. 'f <br /> Y /� r, / , <br /> wner's Name-...ST�h�>f#. �..®.�r7pl/e. ''QJLP�rpd�Fc/4� <br /> ddress ...ed r46,k.�(,� . ..:... .... I . city. ..4r774V... . .. '..--.Zip ►.;.!?/.. ...._.., <br /> .... <br /> ontractor's Name... License <br /> Y��..c��- /.?7'�fe.�iQi�.�+9�C,-- lie....... �� 3 Pl;one <br /> Installation will serve: Residence Q Apprtment House Commercial ❑ Trailer Court ❑ <br /> Motel Other....W4.44# 0ift ...... /OPFoAL!�/yJyXyl��/q•GVW <br /> Number of living units:..y».....Number of ibedro6s.... _.Garbage Grinder......Lot Size......�� '::x,a 7.(.......... .... <br /> Water Supply: Public System and ribme .............. ... .... .... .. ........ ....... .. .. cy _..........Privaterclk <br /> , <br /> Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam <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 public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT ( ] SEPTIC TANK Size... <br /> I� ww_�SX .�A�-._-I. ............. . __......_Liquid Depth .... <br /> Capacity...� .�Type * Materlal..(rQwfi+ •_.. No. Compartments........r �. . ... <br /> Distance to nearest: Well.• _.- �---Foundation ...Prop.� Line' ' i 4 <br /> LEACHING LINE O No. of Lines-. .� ..... Length of each Ime.:::�Q�t, ... .,."` TotaljLength .....bQe.. _...-. ... <br /> D' Box..: _ Type Filter Material................... Depth Filter Material_ _.... ..-.. ------........................................... <br /> Distance to nearest: Well........../$Q...-...Foundation._..-.+ilei__..... ..Property Line.....*0104se.w.�.....1t.......... <br /> SEEPAGE PIT [ ] Depth...4r,�Dlameter. ,,"~ Number /- _.-. -- Rock Filled Yes E[yislo 0 <br /> ,0 <`�. <br /> € -- Water Table Depth .:-_.. ��.I f Rock Size . . ..... j <br /> „ ,... / <br /> Distance to nearest. Well ... ee1 Foundation...., . ... . ...Prop. Line . - .04-04. <br /> REPAIR/ADDITION (Prev. Sanitation Permit#...................................................Date................. ...._...................... <br /> I <br /> i <br /> Septic Tank (Specify Requirements)...... .- .... ..... ...._..............._.............•-----------------.' <br /> Disposal Field (Specify Requirements).................. ........................ <br /> ..... . ---. ............._... .......... ....... •. -' .- -•............................................. -- -- ......_............ ---....... --..........-.-.........------ <br /> - ......................................................... <br /> (Draw existing and required addition on reverse side) <br /> 1 hereby certify that I have prepared this application and that the work will be done in accrdance 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 <br /> su�bIbct .t.o. Workman's <br /> o. r..kman's CompensaOn ws Colifof\n <br /> io." <br /> Signed --- :i-Owner.. ...... <br />—By......... - ------...... .........-.........Title..... <br /> _..............._....._..... ......... ----.._.: ...... <br /> -of h rner) ...-- <br /> er <br /> FOS DEPARTO!ENJ USE MLY <br /> -\PPLICATION ACCEPTED BY........... ! <br /> w ..-. .. .�.- .. ..................... ...........DATE :........:. .�.X... .. <br /> IVISIONOF LAND NUMBER................................... ............ .............._..........I...................._.L..... DATE............... ... .......,.....- yy......_ <br /> DDITIONAL COMMENTS. .............._.......-......... : i:: <br /> 7. .......................... <br /> ...._. <br /> ..................... ............................................................................................ ............................. .. ..................................... . <br /> . <br /> ..............7............ .. . . . .......... ... ....................... ..;:......... ....... .. ....... - <br /> .. . <br /> inal Inspi6on by: �i lilt/ .. ... Date. . ,9.� � 5... � <br /> Is 24 SAN JOAQUIN LOCAL HEALTH DISTRICT - res slap sev.zire ern <br /> TIC <br /> -- 5'-R"-•-"�ilili i 'u oin 'nT <br />