Laserfiche WebLink
a .V FOR OFFICE USE: FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT 7^-/�- <br /> -------------- - ---------------------------- Permit No.- --- --- ------ <br /> (Complete in Triplicate) 7_;; 4 <br /> rA Date Issued---------------- -- <br /> -- -------------------- --­ _ This Permit Expires I Year From Date Issued —r— <br /> This <br /> _ <br /> Application is hereby made to the San Joaquin Local HealthDistr`ict'far'a permit to construct and install the work her9ne described. <br /> This application is made in compliance with Co ty Ordinance No. 549 d existong,Rules and Regulations: ' I <br /> JOB ADDRESS/EOCATION ..4 .© -_ vm?7..VW&I4----ed--------- -�---------,p-- -CENSUS TRACT. <br /> Owner's Name.--- CQ.tLtl.Ilri ------- 'lC.l_ ati�Tk.tte57`n_ �- -- _ �� <br /> - <br /> ---.Phone--- <br /> Address.------------------- � .r._ �-�/ <br /> lie-...-....City ------Zip--- ------•------------------- <br /> Contractor's Name...... ...i -1�.1�.1,5'.�1.. ±`_ Q- '-;_,�rce,.------License -----Phone <br /> Installation will serve: Residence j', Apartment House.❑ Commercial ❑ Trailer Court ❑ <br /> Motel ❑ Other- ------------------- -"I-- <br /> Number'df1i'ving units:---_!-.____Number of,bedrooms.�------Garbage Grinder..____---.Lot.Size.._ .� ._____ -- -a. ........... <br /> Water Supply: Pub c'System and 'name....... --_ -_: --- ____Private <br /> ---- ------- <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay E]-".. Peat"❑ Sandy Loam ❑ .5 gciy Loam E],. Hardpan Adobe Fill Material _ ff es, t e----------------------- <br /> .............. . " ,.-..-. <br /> (Plot plan;`showing size of 1ot, location of system inuelation to well.s,445uilclingSTeta:-must-be.placed•on reverse-side.[- <br /> NEW INSTALLATION: :(No-sReptic-�t-an-k-or--seepage pit permitted if public sewer is available within 200 feet] <br /> PACKAGE TREATMENT [ ] SEPTIC T�NK Size _ _f;1�, _ .f Liquid Depth._-__�~'''e� P I <br /> �S ----------------- - <br /> € tr Ltapaclty_�_�i�?Q- Ype- �- �_�_Material_C6Ae __T.Z-...No. Compartments-----2-------------------------- <br /> tarriZ ` L res �------- ----------------°--.Foundation-----------�----- ---Pro Line----- 0 e <br /> Distance to-nearest: Well.._'�.._.�_ p,. �- .- <br /> -- ..Iota) Length e1-� <br /> LEACHING LINE. No..of Lines. _-.___;_,,_,_..Len th of ea line--__- Q __ ._ g __-- --- <br /> I !'� <br /> ] D' Box_-.: .' LType Filter terial.._ Depth Filter Material------ -------------------------------------- -------- <br /> ti'<r Distance to nearest: M, 1 ' <br /> arest: Wel ...-------------Foundation---aZ.�._-------------Property Line--------------- --------- <br /> SEEPAGE PIT CX v Depth___iS.��?-.s-.Diameter.__ _ --------Num f.- -- Rock Filled Yes No <br /> r « o' <br /> :" . Water Table'Depth--- -9�-- 7"e"----------------------------------Rock Size li.-'�--- 7`-- 9-`�---------- <br /> Distance to nearest: Well.;.....x..._._ ___-____...............Foundation_ _-_L�.�..-__..Prop, Line .. ......:-' <br /> REPAIR/ADDITION (Prev. Sanitation,Pe_emit#..-__.__�___________________-------._...._-....._D t" _ _ .....�� f <br /> ti ' M <br /> Septic Tank (Specify,Requirements[.- ------- ---- ------------------------- ------------------ = ----------------------- ------------------------ <br /> Disposal`Field (Specify Requirements),_.------------' ` - -- ---------------------------------------------------------------------------------------------- <br /> ------------------------ <br /> ------------- <br /> - - ----------------- ---- —------- .- <br /> -----=---------------------- --------------- --------- -------------------------------------------------------------------------------------------------------------------- -------- --------- <br /> (Draw existing and required addition on reverse side) I; <br /> I hereby certify that I have prepared this application and that the work will be donerin�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 /> 4 <br /> "I certify that in the erformance of the work'fog which'this permit is issued, -I shall not employ any person in such manner as <br /> to becom subject o orkman's Comp nsation ws of California." <br /> 54 <br /> Signed > = ` -------- --------- a <br /> BY = -Title <br /> ------ <br /> (If other tha owner) <br /> FOR DEPARTMENT USE ONLY , <br />,i APPLICATION ACCEPTED BY---- - ----------------------------------------------------------------------------DATE.-----I -ilk''_-- ------ - ----- --------- <br /> DIVISION OF LAND NUMBER-- - --------- ----------- - ---- ---------------------------------------------------------------------- DATE.------- -- --------------- ---- --`----- <br /> ADDITIONAL COMMENTS-----------------------------------'--- ------------------- <br /> - - s <br /> -------------------------------------------- --- -----------------------------------------------=-------------------- ------------------------------------------------ -------------------------------------- <br /> - - r <br /> Final Inspection by: - Date-_3 - <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH.DISTRICT F&S 21677 REV, 7176 3M <br />