Laserfiche WebLink
--_.- - FOR OFFICE USE: <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 4 <br /> --- -- -------- <br /> -7-7 <br /> ------ a Permit No._.77 7�_ <br /> (Complete in Triplicate) <br /> �� <br /> k(10 - - - L ----------------- a-7- ----------- - ----- - - I Date Issued---� `3 ------- <br /> _------------------ This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San'J:oaquin 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: - f <br /> ' <br /> CENSUS TRACT. <br /> JOB ADDRESS/LOCATION. _ rI3 ---S--------- -----r---- --------- <br /> _ <br /> --- - � { , <br /> Phone <br /> Owner's Na <br /> � Zip <br /> Address { _ <br /> License <br /> ---- ---- <br /> Contractor's Name - y #�GY �� � Phone_. 2` ��j <br /> - .. p - <br /> Installation will serve: Residence [X Apartment House❑ Commercial ❑ Trailer Court ❑ i E <br /> Motel ❑. House El <br /> ----------- ----- <br /> l <br /> •- Garbage Grinder__ Lot Size `1 <br /> Number of bedrooms_.. ,,��--�. - <br /> Number ppi�in units- --- --------- -Num P 14___--------Private <br /> Water Supply: Public System and name------------------ ---------------- ---------- .- -------- -------- <br /> Sandy <br /> ------ . pper�•` r �h <br /> Character of soil to a depth of 3 feet: +Sand} Silt❑ Clay ❑ Peat❑ Sandy L$arri �� Clay Loam ' <br /> r <br /> Hardpan E] Adobe E] Fill Material._ -------- Yes, type- -----f-- 5- `------ <br /> (Plot plan, showing size of lot, location of system in relation to.wells, buildings, etc. must bplaced on reverse side.) <br /> NEW INSTALLATION----�INo-rseptic-tcrnk nor seepage }pit permitted'if public sewer is available wit ir1"200 feefi,M <br /> d/T�t l� � ----------------- <br /> Size-- _-_ -/ J-- ----Liquid Depth_i <br /> PACKAGE TREATMENT [ ]"'s SEPTIC TANK [ ] . - p t t <br /> i Capacity_ D8 Yp _ atarial-- -----------1 .No. Compartments--;--�------------------------ <br /> i <br /> T e M . -Foundation:-_ ------`-..Prop.-Line- <br /> Distance <br /> •.Prop-Line_ 5r <br /> Distance to nearest: Well..__,- __ - .._­------- � <br /> �tal <br /> t <br /> ' F` `5 <br /> {Length. ' <br /> ---------------------- <br /> ---------! __.__ -- Lengh f each Ii <br /> LEACHING LINE: No. of Linesaterial , Y-----b----- ---------- ---- <br /> _ _, - De th ilr Matejj- <br /> D Box_ ---Type Filter M -i 'Property Line. - ------ ------ <br /> Distance to nearest: WeI0---------- Founatn ___d <br /> ' ! <br /> SEEPAGE PIT [ ] Depth-----' -- <br /> ----------.Diameter- -----------------Number Rock Filled Yes E] No ❑ <br /> i Water Table:Depth--- --------------.------- ------------ ------------------Rock Size <br /> --------------- <br /> I ------Foundation- ---------- -------Prop. Line ---------------- <br /> Distance.to.nearest: Well_ ------ -------------- <br /> (Prev. Sanitation Permit#----------------------------------------------------Date---.-_-.---- ,I-------------- <br /> ------------------------------------------- <br /> w------------- <br /> REPAIR/ADDITION <br /> Septic.Tank (Specify Requirements)-------- -=- ----=---------------------------- --------- ---- <br /> - ------------ <br /> Disposal Field (Specify Requirements)i_-_--=-------.------- ------ ---- - <br /> ----------------- <br /> ------------ <br /> - --------- ------ - -- - - - --------------- -------------- <br /> _______________________ <br /> 4 <br /> _______ r - --------------------------------------------------------------------.---...__ - i <br /> � F (Draw existing and required <br /> this-a li"atlon and t addition on reverse side <br /> 3 <br /> 1 hereby certify that l have prepared._ pp hat the work will be done in accordance with San Joaquin County <br /> s <br /> r Ordinances,. State Laws; and Rules and Regulations of4the San Joaquin Local Health District. Home owner or licensed agents <br /> signature certifies the following: - _ _ <br /> l <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 <br /> to become subject.to, Workman,s Compensation laws of� California.'.: .. <br /> t .Owner M F <br /> Signed----- ---- --------- ----- <br /> _ •__.. <br /> --------- <br /> k ` /" -•,- .-�� __.._------- ------------------------------------------ <br /> = --=- ---- -------- -- -Title----- - --- =---- <br /> By--- � F <br /> + {1f other than ow r) <br /> 4 FOR DEPARTMENT,USE ONLY.,�,­4 <br /> F <br /> ------------ <br /> = - DATE ' Z <br /> I. <br /> DIVISION OF LAND NUMBER.___ - _ DATE.__ .._------------- "---- <br /> APPLICATION ACCEPTED- BY .- ._.-- ',_--.-: ' -- --. --_- �--_--__ -----� - - - �-2�� <br /> 77�+ <br /> ADDITIONAL COMMENTS-------------- � <br /> ------------------ -- <br /> - <br /> ----------------- ------------- <br /> -•-------------- ------ <br /> --------------------- <br /> ------------------------ _ -- <br /> ------------------------ --- ---- - Date ------- ---------- <br /> Final InspectiobF&S 21677 REV, / 6 3M <br /> r � <br /> EH 13 24 - - --. SAN J AQUIN LOCAL HEALTH DISTRICT _ <br />